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Sample records for cord injury patient

  1. Neurogenic bladder in spinal cord injury patients

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    Al Taweel W

    2015-06-01

    Full Text Available Waleed Al Taweel, Raouf SeyamDepartment of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi ArabiaAbstract: Neurogenic bladder dysfunction due to spinal cord injury poses a significant threat to the well-being of patients. Incontinence, renal impairment, urinary tract infection, stones, and poor quality of life are some complications of this condition. The majority of patients will require management to ensure low pressure reservoir function of the bladder, complete emptying, and dryness. Management typically begins with anticholinergic medications and clean intermittent catheterization. Patients who fail this treatment because of inefficacy or intolerability are candidates for a spectrum of more invasive procedures. Endoscopic managements to relieve the bladder outlet resistance include sphincterotomy, botulinum toxin injection, and stent insertion. In contrast, patients with incompetent sphincters are candidates for transobturator tape insertion, sling surgery, or artificial sphincter implantation. Coordinated bladder emptying is possible with neuromodulation in selected patients. Bladder augmentation, usually with an intestinal segment, and urinary diversion are the last resort. Tissue engineering is promising in experimental settings; however, its role in clinical bladder management is still evolving. In this review, we summarize the current literature pertaining to the pathology and management of neurogenic bladder dysfunction in patients with spinal cord injury.Keywords: neurogenic bladder, spinal cord injury, urodynamics, intestine, intermittent catheterization

  2. Characteristics and rehabilitation for patients with spinal cord stab injury

    Science.gov (United States)

    Wang, Fangyong; Zhang, Junwei; Tang, Hehu; Li, Xiang; Jiang, Shudong; Lv, Zhen; Liu, Shujia; Chen, Shizheng; Liu, Jiesheng; Hong, Yi

    2015-01-01

    [Purpose] The objective of the study was to compare the incidence, diagnosis, treatment, and prognosis of patients with spinal cord stab injury to those with the more common spinal cord contusion injury. [Subjects] Of patients hospitalized in China Rehabilitation Research Center from 1994 to 2014, 40 of those having a spinal cord stab injury and 50 with spinal cord contusion were selected. [Methods] The data of all patients were analyzed retrospectively. The cases were evaluated by collecting admission and discharge ASIA (American Spinal Injury Association) and ADL (activity of daily living) scores. [Results] After a comprehensive rehabilitation program, ASIA and ADL scores of patients having both spinal cord stab injury and spinal cord contusion significantly increase. However, the increases were noted to be higher in patients having a spinal cord stab injury than those having spinal cord contusion. [Conclusion] Comprehensive rehabilitation is effective both for patients having spinal cord stab injury and those with spinal cord contusion injury. However, the prognosis of patients having spinal cord stab injury is better than that of patients with spinal cord contusion. PMID:26834329

  3. Nursing rehabilitation of patients with spin and spinal cord injuries

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    Stavrou V.

    2012-04-01

    Full Text Available The injury of the Spine cord is a major problem because of the high mortality and morbidity in patients. Despite the advanced medical care and specialized rehabilitation the life expectancy of people with injuries of the spinal cord is lower than the general population. Hospitalization in modern rehabilitation centers reduces the mortality and severity of the complications with comprehensive programs which include the prevention of complications. It also educates the patient and his carer with psychological and social support. The nursing interventions have perhaps the most significant impact on the area of functional independence, rehabilitation and the quality of the patients life. The development of better rehabilitation programs will improve the life of people with injury of the spine and Spinal Cord.

  4. Quality of Life in Patients with Spinal Cord Injury

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    Gurcay, Eda; Bal, Ajda; Eksioglu, Emel; Cakci, Aytul

    2010-01-01

    The primary objective of this study was to assess the quality of life (QoL) in spinal cord injury (SCI) survivors. Secondary objectives were to determine the effects of various sociodemographic and clinical characteristics on QoL. This cross-sectional study included 54 patients with SCI. The Turkish version of the Short-Form-36 Health Survey was…

  5. Quality of Life in Patients with Spinal Cord Injury

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    Gurcay, Eda; Bal, Ajda; Eksioglu, Emel; Cakci, Aytul

    2010-01-01

    The primary objective of this study was to assess the quality of life (QoL) in spinal cord injury (SCI) survivors. Secondary objectives were to determine the effects of various sociodemographic and clinical characteristics on QoL. This cross-sectional study included 54 patients with SCI. The Turkish version of the Short-Form-36 Health Survey was…

  6. Traumatic brain injury is under-diagnosed in patients with spinal cord injury.

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    Tolonen, Anu; Turkka, Jukka; Salonen, Oili; Ahoniemi, Eija; Alaranta, Hannu

    2007-10-01

    To investigate the occurrence and severity of traumatic brain injury in patients with traumatic spinal cord injury. Cross-sectional study with prospective neurological, neuropsychological and neuroradiological examinations and retrospective medical record review. Thirty-one consecutive, traumatic spinal cord injury patients on their first post-acute rehabilitation period in a national rehabilitation centre. The American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury were applied. Assessments were performed with neurological and neuropsychological examinations and magnetic resonance imaging 1.5T. Twenty-three of the 31 patients with spinal cord injury (74%) met the diagnostic criteria for traumatic brain injury. Nineteen patients had sustained a loss of consciousness or post-traumatic amnesia. Four patients had a focal neurological finding and 21 had neuropsychological findings apparently due to traumatic brain injury. Trauma-related magnetic resonance imaging abnormalities were detected in 10 patients. Traumatic brain injury was classified as moderate or severe in 17 patients and mild in 6 patients. The results suggest a high frequency of traumatic brain injury in patients with traumatic spinal cord injury, and stress a special diagnostic issue to be considered in this patient group.

  7. Assessment of Hyperactive Reflexes in Patients with Spinal Cord Injury

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    Yang, Chung-Yong

    2015-01-01

    Hyperactive reflexes are commonly observed in patients with spinal cord injury (SCI) but there is a lack of convenient and quantitative characterizations. Patellar tendon reflexes were examined in nine SCI patients and ten healthy control subjects by tapping the tendon using a hand-held instrumented hammer at various knee flexion angles, and the tapping force, quadriceps EMG, and knee extension torque were measured to characterize patellar tendon reflexes quantitatively in terms of the tendon reflex gain (G tr), contraction rate (R c), and reflex loop time delay (t d). It was found that there are significant increases in G tr and R c and decrease in t d in patients with spinal cord injury as compared to the controls (P reflex excitability and muscle contraction dynamics. With proper simplifications, it can potentially be used for quantitative diagnosis and outcome evaluations of hyperreflexia in clinical settings. PMID:25654084

  8. Emotional Intelligence in Patients with Spinal Cord Injury (SCI).

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    Saberi, Hooshang; Ghajarzadeh, Mahsa

    2017-05-01

    Spinal Cord Injury (SCI) is a devastating situation. Spinal Cord Injury affects functional, psychological and socioeconomic aspects of patients' lives. The ability to accomplish and explicate the one's own and other's feelings and emotions to spread over appropriate information for confirming thoughts and actions is defined as emotional intelligence (EI). The goal of this study was to evaluate depression and EI in SCI patients in comparison with healthy subjects. One-hundred-ten patients with SCI and 80 healthy subjects between Aug 2014 and Aug 2015 were enrolled. The study was conducted in Imam Hospital, Tehran, Iran. All participants were asked to fill valid and reliable Persian version Emotional Quotient inventory (EQ-i) and Beck Depression Inventory (BDI). All data were analyzed using SPSS. Data were presented as Mean±SD for continuous or frequencies for categorical variables. Continuous variables compared by means of independent sample t-test. P-values less than 0.05 were considered as significant. Mean age of patients was 28.7 and mean age of controls was 30.2 yr. Spinal cord injury in 20 (18.3%) were at cervical level, in 83 (75.4%) were thoracic and in 7 (6.3%) were lumbar. Mean values of independence, stress tolerance, self-actualization, emotional Self-Awareness, reality testing, Impulse Control, flexibility, responsibility, and assertiveness were significantly different between cases and controls. Mean values of stress tolerance, optimism, self-regard, and responsibility were significantly different between three groups with different injury level. Most scales were not significantly different between male and female cases. Emotional intelligence should be considered in SCI cases as their physical and psychological health is affected by their illness.

  9. Respiratory Management in the Patient with Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Rita Galeiras Vázquez

    2013-01-01

    Full Text Available Spinal cord injuries (SCIs often lead to impairment of the respiratory system and, consequently, restrictive respiratory changes. Paresis or paralysis of the respiratory muscles can lead to respiratory insufficiency, which is dependent on the level and completeness of the injury. Respiratory complications include hypoventilation, a reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Vital capacity (VC is an indicator of overall pulmonary function; patients with severely impaired VC may require assisted ventilation. It is best to proceed with intubation under controlled circumstances rather than waiting until the condition becomes an emergency. Mechanical ventilation can adversely affect the structure and function of the diaphragm. Early tracheostomy following short orotracheal intubation is probably beneficial in selected patients. Weaning should start as soon as possible, and the best modality is progressive ventilator-free breathing (PVFB. Appropriate candidates can sometimes be freed from mechanical ventilation by electrical stimulation. Respiratory muscle training regimens may improve patients’ inspiratory function following a SCI.

  10. Patients with Spinal Cord Injuries Favor Administration of Methylprednisolone.

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    Christian A Bowers

    Full Text Available Methylprednisolone sodium succinate (MPSS for treatment of acute spinal cord injury (SCI has been associated with both benefits and adverse events. MPSS administration was the standard of care for acute SCI until recently when its use has become controversial. Patients with SCI have had little input in the debate, thus we sought to learn their opinions regarding administration of MPSS. A summary of the published literature to date on MPSS use for acute SCI was created and adjudicated by 28 SCI experts. This summary was then emailed to 384 chronic SCI patients along with a survey that interrogated the patients' neurological deficits, communication with physicians and their views on MPSS administration. 77 out of 384 patients completed the survey. 28 respondents indicated being able to speak early after injury and of these 24 reported arriving at the hospital within 8 hours of injury. One recalled a physician speaking to them about MPSS and one patient reported choosing whether or not to receive MPSS. 59.4% felt that the small neurological benefits associated with MPSS were 'very important' to them (p<0.0001. Patients had 'little concern' for potential side-effects of MPSS (p = 0.001. Only 1.4% felt that MPSS should not be given to SCI patients regardless of degree of injury (p<0.0001. This is the first study to report SCI patients' preferences regarding MPSS treatment for acute SCI. Patients favor the administration of MPSS for acute SCI, however few had input into whether or not it was administered. Conscious patients should be given greater opportunity to decide their treatment. These results also provide some guidance regarding MPSS administration in patients unable to communicate.

  11. Dermatological problems following spinal cord injury in Korean patients

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    Han, Zee-A; Choi, Ja Young; Ko, Young Jin

    2015-01-01

    Objective To identify dermatological conditions following spinal cord injury (SCI) and analyze these conditions in relation to various characteristics of SCI. Design Retrospective chart review. Setting National Health Insurance Corporation Ilsan Hospital of Korea, Rehabilitation Center, Spinal Cord Unit. Participants Patients treated for SCI who were referred to dermatology for dermatological problems, 2000–2012. Results Of the 1408 SCI patients treated at the spinal cord unit, 253 patients with SCI were identified to have been referred to dermatology for skin problems and a total of 335 dermatological conditions were diagnosed. The most common dermatological finding was infectious (n = 123, 36.7%) followed by eczematous lesions (n = 109, 32.5%). Among the infectious lesions, fungal infection (n = 76, 61.8%) was the most common, followed by bacterial (n = 27, 21.9%) lesions. Seborrheic dermatitis (n = 59, 64.1%) was the most frequent eczematous lesion. Ingrown toenail occurred more frequently in tetraplegics whereas vascular skin lesions occurred more commonly in patients with paraplegia (P < 0.05). Xerotic dermatitis showed a higher occurrence within 12 months of injury rather than thereafter (P < 0.05). Of these, 72.4% of the infectious and 94.7% of the fungal skin lesions manifested below the neurological level of injury (NLI; P < 0.001) and 61.5% of the eczematous lesions and 94.9% of seborrheic dermatitis cases occurred above the NLI (P < 0.001). There was no significant difference in dermatological diagnoses between patients with neurologically complete and incomplete SCI. Conclusion The most common dermatological condition in patients with SCI among those referred to dermatology was fungal infection, followed by seborrheic dermatitis. Although dermatological problems after SCI are not critical in SCI outcome, they negatively affect the quality of life. Patients and caregivers should be educated about appropriate skin care and routine

  12. Synergistic impact of acute kidney injury and high level of cervical spinal cord injury on the weaning outcome of patients with acute traumatic cervical spinal cord injury.

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    Yu, Wen-Kuang; Ko, Hsin-Kuo; Ho, Li-Ing; Wang, Jia-Horng; Kou, Yu Ru

    2015-07-01

    Respiratory neuromuscular impairment severity is known to predict weaning outcome among patients with cervical spinal cord injury; however, the impact of non-neuromuscular complications remains unexplored. This study was to evaluate possible neuromuscular and non-neuromuscular factors that may negatively impact weaning outcome. From September 2002 to October 2012, acute traumatic cervical spinal cord injury patients who had received mechanical ventilation for >48h were enrolled and divided into successful (n=54) and unsuccessful weaning groups (n=19). Various neuromuscular, non-neuromuscular factors and events during the intensive care unit stay were extracted from medical charts and electronic medical records. Variables presenting with a significant difference (pspinal cord injury (C1-3), lower pulse rates, and lower Glasgow Coma Scale score on admission, higher peak blood urea nitrogen, lower trough albumin, and lower trough blood leukocyte counts. Furthermore, unsuccessful weaning patients had a higher incidence of pneumonia, acute respiratory distress syndrome, shock and acute kidney injury during the intensive care unit stay. Multivariate logistic regression analysis revealed acute kidney injury and high level of cervical spinal cord injury were independent risk factors for failure of weaning. Importantly, patients with both risk factors showed a large increase in odds ratio for unsuccessful weaning from mechanical ventilation (pinjury during the intensive care unit stay and high level of cervical spinal injury are two independent risk factors that synergistically work together producing a negative impact on weaning outcome. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Reaction to topical capsaicin in spinal cord injury patients with and without central pain

    DEFF Research Database (Denmark)

    Finnerup, Nanna Brix; Pedersen, Louise H.; Terkelsen, Astrid J.

    2007-01-01

    Central neuropathic pain is a debilitating and frequent complication to spinal cord injury (SCI). Excitatory input from hyperexcitable cells around the injured grey matter zone is suggested to play a role for central neuropathic pain felt below the level of a spinal cord injury. Direct evidence...... of a spinal cord injury which already is hyperexcitable, would cause enhanced responses in patients with central pain at the level of injury compared to patients without neuropathic pain and healthy controls. Touch, punctuate stimuli, cold stimuli and topical capsaicin was applied above, at, and below injury...... level in 10 SCI patients with central pain below a thoracic injury, in 10 SCI patients with a thoracic injury but without neuropathic pain, and in corresponding areas in 10 healthy control subjects. The study found increased responses to touch at injury level compared to controls (p = 0...

  14. Optimal Colostomy Placement in Spinal Cord Injury Patients.

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    Xu, Jiashou; Dharmarajan, Sekhar; Johnson, Frank E

    2016-03-01

    Barring unusual circumstances, sigmoid colostomy is the optimal technique for management of defecation in spinal cord injury (SCI) patients. We sought to provide evidence that a sigmoid colostomy is not difficult to perform in SCI patients and has better long-term results. The St. Louis Department of Veterans Affairs has a Commission on Accreditation of Rehabilitation Facilities (CARF)-approved SCI Unit. We reviewed the operative notes on all SCI patients who received a colostomy for fecal management by three ASCRS-certified colorectal surgeons at the St. Louis Department of Veterans Affairs from January 1, 2007 to November 26, 2012. There were 27 operations for which the recorded indication for surgery suggested that the primary disorder was SCI. Fourteen had traumatic SCI of the thoracic and/or lumbar spine and were evaluable. Of these 14 patients, 12 had laparoscopic sigmoid colostomy and two had open sigmoid colostomy. We encountered one evaluable patient with a remarkably large amount of retroperitoneal bony debris who successfully underwent laparoscopic sigmoid colostomy. In conclusion, sigmoid colostomy is the consensus optimal procedure for fecal management in SCI patients. Laparoscopic procedures are preferred. Care providers should specify sigmoid colostomy when contacting a surgeon.

  15. Occurrence and predictors of pressure ulcers during primary in-patient spinal cord injury rehabilitation

    NARCIS (Netherlands)

    Verschueren, J. H. M.; Post, M. W. M.; de Groot, S.; van der Woude, L. H. V.; van Asbeck, F. W. A.; Rol, M.

    Study design: Multicenter prospective cohort study. Objectives: To determine the occurrence and predictors for pressure ulcers in patients with spinal cord injury (SCI) during primary in-patient rehabilitation. Setting: Eight Dutch rehabilitation centres with specialized SCI units. Methods: The

  16. The Assessment of Bladder and Urethral Function in Spinal Cord Injury Patients

    Institute of Scientific and Technical Information of China (English)

    Zhong CHEN; Shuangquan SUN; Rongjin DENG; Dan CAI; Xiaoyi YUAN; Guanghui DU; Weimin YANG; Zhangqun YE

    2009-01-01

    The correlation between the anatomic site of spinal cord injury and real-time conditions of bladder and urethral function was assessed in order to provide a reasonable basis for the clinical treat-ment of neurogenic bladder. A total of 134 patients with spinal cord injuries (105 males, 29 females;averaged 34.1 years old) were involved in this retrospective analysis, including urodynamic evaluation,clinical examination and imaging for anatomical position, and Bors-Comarr classification. The associa-tions between the levels of injury and urodynamic findings were analyzed. The results showed that mean follow-up duration was 16.7 months (range 8-27 months). Complete spinal cord injuries occurred in 21 cases, and incomplete spinal cord injuries in 113 cases. Of the 43 patients with upper motor neu-ron (UMN) injuries, hyperreflexia and (or) detmsor sphincter dyssynergia were demonstrated in 30 (69.8%), 31 (72.1%) suffered low bladder compliance (less than 12.5 mL/cmH2O), 28 (65.1%) had high detrusor leak point pressures (greater than 40 cmH2O), and 34 (79.1%) had residual urine. Of the 91 pa-tients with lower motor neuron (LMN) injuries, areflexia occurred in 78 (85.7%), high compliance in 75 (82.4%), low leak point pressures in 80 (87.9%), and residual urine in 87 (95.6%), respectively. The as-sociations between the anatomical site of spinal cord injury and urodynamic findings were ill defined. In patients with spinal cord injury, this study revealed a significant association between the level of injury and the type of voiding dysfunction. The anatomical site of spinal cord injury can not be predicted in real-time condition of bladder and urethral function. Management of neurogenic bladder in patients with spinal cord injury must be based on urodynamic findings rather than inferences from the neurologic evaluation.

  17. EARLY MEDICAL REHABILITATION OF THE PATIENTS WITH SPINAL CORD INJURY

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    Aleš Demšar

    2003-12-01

    Full Text Available Background. Early medical rehabilitation (EMR of the patients with spinal cord injury is discussed in this article.For successful rehabilitation adequate surgical treatment, which enables early verticalisation, is compulsory.Predictable respiratory, vascular, intestinal and urologic complications, contractures and bed sores are described and algorhytms of EMR in the period of spinal shock and after, until transferring the patient to the IRSR, are presented.Respiratory therapy, thromboprophylaxis, kinesiotherapy and functional electrical stimulation as well as the methods of early bladder and bowel control, contractures and bed sores prevention, as procedures of EMR are fully presented.With special importance early verticalisation from the 5th post operative day with help of the tilt table is presented as the key point of EMR.Conclusions. With aggressive EMR the paraplegic patient is able to gain erect posture from the 5th post operative day, sits in a wheel chair from 10th to 14th day and stands in the paralel bar from 15th day on.

  18. Spinal Cord Injuries

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    ... your body and your brain. A spinal cord injury disrupts the signals. Spinal cord injuries usually begin with a blow that fractures or ... bone disks that make up your spine. Most injuries don't cut through your spinal cord. Instead, ...

  19. Neuropathic pain in patients with spinal cord injury: report of 213 patients

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    Manoel Jacobsen Teixeira

    2013-09-01

    Full Text Available Objective Management of neuropathic pain following spinal cord injury (SCI can be a frustrating experience for patients since it poses a therapeutic challenge. In this article the authors describe the clinical characteristics of a group of patients with pain after spinal cord injury. Methods In this retrospective study, 213 patients with SCI and neuropathic pain were assessed. We analyzed clinical characteristics, treatment options, and pain intensity for these patients. Results The main cause of SCI was spine trauma, which occurred in 169 patients, followed by tumors and infection. Complete lesions were verified in 144 patients. In our study, patients with traumatic SCI and partial lesions seem to be presented with more intense pain; however, this was not statistically significant. Conclusions Neuropathic pain is a common complaint in patients with SCI and presents a treatment challenge. Knowledge of the clinical characteristics of this group of patients may help determine the best approach to intervention.

  20. Prosthetic restoration in patient with incomplete spinal cord injury.

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    Mustafah, Nadia Mohd; Bakar, Noriani Abu; Yang, Chung Tze

    2016-01-01

    We describe a case of 55-years-old man with a known T11 AIS C since 1985. The muscle strength of his left leg is better than the right leg and he is an active community ambulator. He walks using his right knee ankle foot orthosis without a knee lock. However, on April 2012 he had undergone a left transtibial amputation secondary to infected diabetic foot ulcer. He only had his first contact with rehabilitation team 2 months after the amputation and started on gait retraining since. Given the fact that he is a K3 level as he used to climb Batu Caves which is known to have 272 steps and he plans to continue this activity for his religious purposes, we prescribed him with prosthesis - patella tendon bearing socket, pin and lock suspension, silicone liner and energy storing foot. In conclusion, a community ambulator in dual disabilities, that is, spinal cord injury and amputee is hardly encountered due to multiple confounding factors. However, the right prosthetic prescription in patient with good prognosticating factors to ambulate will determine successful rehabilitation.

  1. Expansion duroplasty improves intraspinal pressure, spinal cord perfusion pressure, and vascular pressure reactivity index in patients with traumatic spinal cord injury: injured spinal cord pressure evaluation study.

    Science.gov (United States)

    Phang, Isaac; Werndle, Melissa C; Saadoun, Samira; Varsos, Georgios; Czosnyka, Marek; Zoumprouli, Argyro; Papadopoulos, Marios C

    2015-06-15

    We recently showed that, after traumatic spinal cord injury (TSCI), laminectomy does not improve intraspinal pressure (ISP), spinal cord perfusion pressure (SCPP), or the vascular pressure reactivity index (sPRx) at the injury site sufficiently because of dural compression. This is an open label, prospective trial comparing combined bony and dural decompression versus laminectomy. Twenty-one patients with acute severe TSCI had re-alignment of the fracture and surgical fixation; 11 had laminectomy alone (laminectomy group) and 10 had laminectomy and duroplasty (laminectomy+duroplasty group). Primary outcomes were magnetic resonance imaging evidence of spinal cord decompression (increase in intradural space, cerebrospinal fluid around the injured cord) and spinal cord physiology (ISP, SCPP, sPRx). The laminectomy and laminectomy+duroplasty groups were well matched. Compared with the laminectomy group, the laminectomy+duroplasty group had greater increase in intradural space at the injury site and more effective decompression of the injured cord. In the laminectomy+duroplasty group, ISP was lower, SCPP higher, and sPRx lower, (i.e., improved vascular pressure reactivity), compared with the laminectomy group. Laminectomy+duroplasty caused cerebrospinal fluid leak that settled with lumbar drain in one patient and pseudomeningocele that resolved completely in five patients. We conclude that, after TSCI, laminectomy+duroplasty improves spinal cord radiological and physiological parameters more effectively than laminectomy alone.

  2. Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: Risk factors and management

    OpenAIRE

    2016-01-01

    Background: High spinal cord injury (HSCI) is one of the devastating traumatic injuries. 80% of these patients are young male, and 93% will have major neurological disabilities. There is a paucity of literature about prolonged bradycardia in HSCI patients. The aim of this study was to know the prevalence, risk factors, precipitating factors for prolonged bradycardia in the HSCI patients. Materials and Methods: All patients who were admitted to the Intensive Care Unit (ICU) of a tertiary hospi...

  3. Timing of Surgery After Spinal Cord Injury.

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    Piazza, Matthew; Schuster, James

    2017-01-01

    Although timing for surgical intervention after spinal cord injury remains controversial, there is accumulating evidence suggesting that early surgery may improve neurologic outcomes, particularly with incomplete spinal cord injury, and may reduce non-neurologic complications and health care resource utilization. Moreover, even in patients with complete spinal cord injury, minor improvement in neurologic function can lead to significant changes in quality of life. This article reviews the experimental and clinical data examining surgical timing after spinal cord injury.

  4. Spinal Cord Injury

    Science.gov (United States)

    ... indicated by a total lack of sensory and motor function below the level of injury. People who survive a spinal cord injury will most likely have medical complications such as chronic pain and bladder and bowel ...

  5. Noninvasive transcutaneous bionic baroreflex system prevents severe orthostatic hypotension in patients with spinal cord injury.

    Science.gov (United States)

    Yoshida, Masayoshi; Murayama, Yoshinori; Chishaki, Akiko; Sunagawa, Kenji

    2008-01-01

    Central baroreflex failure in patients with spinal cord injury results in serious orthostatic hypotension. We examined if transcutaneous electrical stimulation regulates arterial pressure in those patients. We identified skin regions capable of increasing arterial pressure and determined respective transfer function. Using the transfer function, we designed the feedback regulator (i.e., bionic baroreflex system) to control arterial pressure. Orthostatic stress decreased arterial pressure profoundly. Activation of bionic regulator restored and maintained arterial pressure at pre-specified levels. We conclude that the transcutaneous bionic system is noninvasive and capable of stabilizing arterial pressure in patients with spinal cord injury.

  6. Electrical nerve stimulation to promote micturition in spinal cord injury patients: A review of current attempts.

    Science.gov (United States)

    Ren, Jian; Chew, Daniel J; Biers, Suzanne; Thiruchelvam, Nikesh

    2016-03-01

    In this review, we focus on the current attempts of electrical nerve stimulation for micturition in spinal cord injury (SCI) patients. A literature search was performed through PubMed using "spinal cord injury," "electrical nerve stimulation AND bladder," "sacral anterior root stimulation/stimulator" and "Brindley stimulator" from January 1975 to January 2014. Twenty studies were selected for this review. Electrical nerve stimulation is a clinical option for promoting micturition in SCI patients. Well-designed, randomized and controlled studies are essential for further investigation. © 2015 Wiley Periodicals, Inc.

  7. Mortality in patients with traumatic spinal cord injury: descriptive analysis of 62 deceased subjects.

    NARCIS (Netherlands)

    Thietje, R.; Pouw, M.H.; Schulz, A.P.; Kienast, B.; Hirschfeld, S.

    2011-01-01

    STUDY DESIGN: Retrospective study. OBJECTIVE: To investigate the causes of death in patients who were cord injury (tSCI). SETTING: Convenience sample of a tertiary rehabilitation center. METHODS: All deceased patients with tSCI who survived a minimum o

  8. The investigation of care burden and coping style in caregivers of spinal cord injury patients

    Directory of Open Access Journals (Sweden)

    Hai-Ping Ma

    2014-06-01

    Conclusion: Primary caregivers of spinal cord injury patients report a heavy burden of care. As active coping strategies are more beneficial, medical care providers should encourage caregivers to make more use of these coping styles to promote physical and mental health for themselves, their patients and their family, as well as to improve the quality of care provided.

  9. [Spinal cord injury in patients over 65 years of age].

    Science.gov (United States)

    Varela-Lage, Cristina; Alcobendas-Maestro, Mónica; Luque-Ríos, Inmaculada; Esclarín-De Ruz, Ana; Talavera-Díaz, Francisco; Ceruelo-Abajo, Silvia

    2015-06-01

    Introduccion. La poblacion de mayores de 65 años activos fisicamente continua en aumento, lo que condiciona un mayor riesgo de caidas y de lesion medular en un rango de edad con importante presencia de patologia cronica. Objetivo. Revisar la incidencia, el tipo de lesion, las complicaciones asociadas y los resultados funcionales de las lesiones medulares ocurridas en pacientes mayores de 65 años. Pacientes y metodos. Estudio descriptivo retrospectivo en lesionados medulares agudos mayores de 65 años ingresados en el Hospital Nacional de Paraplejicos desde enero de 2010 hasta diciembre de 2011. Las variables del estudio fueron datos demograficos y de lesion, antecedentes personales, complicaciones ocurridas durante el ingreso y capacidad funcional al alta medida con las escalas Spinal Cord Independence Measure (SCIM III) y Walking Index Spinal Cord Injury (WISCI). Resultados. Se incluyeron 111 individuos con una media de edad de 72,5 años. La incidencia anual fue de 17,3 pacientes/100 ingresos. El 33,3% eran lesiones cervicales y fueron incompletas el 66,7%. La etiologia medica fue mas frecuente que la traumatica. El 5% no presentaba otras enfermedades intercurrentes. El 97% sufrio algun tipo de complicacion. La media alcanzada para la SCIM III fue de 42 puntos y el 35% consiguio capacidad de marcha. Conclusiones. En los ultimos años se ha producido un aumento de lesion medular en mayores de 65 años, en los que la etiologia traumatica no es superior a la medica; mas frecuentemente son lesiones incompletas que asocian mayor comorbilidad que la poblacion general, y se consiguen resultados funcionales mas pobres a pesar de las mejoras neurologicas.

  10. Evaluationof efficiency of methods of neuromodulation in the treatment of spastic syndromes in patients with spinal cord injury

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    Smolkin А.А.

    2014-12-01

    Full Text Available Objective: to evaluate the efficiency of the neuromodulation methods and to determine their role in complex rehabilitation of patients with spastic syndromes after spinal cord injury. Material and methods: Based on the study and treatment of 105 patients with spastic syndromes after injury of the spinal cord, electrical stimulation of the spinal cord, epidural drug therapy in combination with electrical nerve stimulation and local hypothermia spinal cord have been consistently applied for the treatment of spastic syndrome. Results: Consistent use of methods of neuromodulation in patients with spastic syndromes after spinal cord injuries are given in 88,6% of cases to obtain positive results. Conclusion: The obtained results allow to estimate efficiency of neuromodulation methods and to determine their role in complex rehabilitation of patients with spastic syndromes after spinal cord injury

  11. Diaphragm functional electrical stimulation (FES weaning in a spinal cord injuried patient

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    Rogério Arruda Melaré

    2008-11-01

    Full Text Available ABSTRACT Spinal cord injury after swimming in shallow water has a greatincidence around the world mainly in young, healthy and male peopleafter alcohol drinking. According to the injury's mechanism and spinal cord anatomy, some individuals can develop respiratory failure and difficult of spontaneous breathing after trauma. Weaning from mechanical ventilation in those patients must be difficult but it must be possible with well driven protocols in association to FES. This case report intends to show that it is possible returning tospontaneous breathing after a well done weaning protocol.

  12. MRI in chronic spinal cord injury patients with and without central pain.

    Science.gov (United States)

    Finnerup, N B; Gyldensted, C; Nielsen, E; Kristensen, A D; Bach, F W; Jensen, T S

    2003-12-09

    Central pain following spinal cord injury (SCI) is common and thought to be related to lesion of the spinothalamic pathways. To examine additional mechanisms of SCI pain. Twenty-three SCI patients with traumatic lesions above T10 (14 with central neuropathic pain and 9 without pain) underwent MRI examination. The authors quantitatively assessed extent of cord lesion on axial T2-weighted images as percentage of 1) gray matter, 2) dorsolateral, 3) anterolateral, and 4) dorsolateral columns based on standardized drawings made by a neuroradiologist blinded to patient history. At the level of maximal cord injury, 21 patients had lesions involving the entire cord on axial images except for a small border of lower signal intensity, whereas 2 patients had central lesions. Rostral to the main injury, the first image with an incomplete lesion showed significantly more involvement of gray matter in pain than in pain-free patients. Consistent with animal models of SCI, spinothalamic tract lesion together with neuronal hyperexcitability due to lesion of inhibitory interneurons at the rostral end of injury are hypothesized to lead to central pain.

  13. Functional outcome of patients with spinal cord injury : rehabilitation outcome study

    NARCIS (Netherlands)

    Schönherr, M.C.; Groothoff, J.W.; Mulder, G.A.; Eisma, W.H.

    1999-01-01

    Objective: To increase our knowledge of neurological recovery and functional outcome of patients with spinal cord injuries in order to make more successful rehabilitation programmes based on realistic goals. Design: Descriptive analysis of data gathered in an information system. Setting: Rehabilitat

  14. Spasticity reduction using electrical stimulation in the lower limb of spinal cord injury patients

    NARCIS (Netherlands)

    van der Salm, Arjan

    2005-01-01

    The goal of this thesis was to investigate the influence of electrical stimulation on spasticity of leg muscles in spinal cord injury patients and its impact on gait. Both, the carry-over effect and the instant effect of electrical stimulation during gait were investigated.

  15. Functional outcome of patients with spinal cord injury : rehabilitation outcome study

    NARCIS (Netherlands)

    Schönherr, M.C.; Groothoff, J.W.; Mulder, G.A.; Eisma, W.H.

    1999-01-01

    Objective: To increase our knowledge of neurological recovery and functional outcome of patients with spinal cord injuries in order to make more successful rehabilitation programmes based on realistic goals. Design: Descriptive analysis of data gathered in an information system. Setting: Rehabilitat

  16. Decubitus grade IV (deep pressure sore) with intact skin in a patient with spinal cord injury

    NARCIS (Netherlands)

    Theunissen, C.C.W.; Zeilstra, J.T.; van Voorst Vader, P.C.; Kardaun, S.H.; Leeman, F.W.J.

    2006-01-01

    Even with intact skin the possibility of pressure sores should not be dismissed. Early recognition of a pressure sore is important for adequate treatment and prevention of progression. Multidisciplinary intervention is essential. A wheelchair patient with spinal cord injury is described, who develop

  17. Neurological outcome in a series of 58 patients operated for traumatic thoracolumbar spinal cord injuries

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    Mauro Dobran

    2014-01-01

    Full Text Available Background: Traumatic thoracolumbar spinal fractures represent approximately 65% of all traumatic spinal fractures and are frequently associated to permanent disability with significant social and economic impact. These injuries create severe physical limitations depending on neurological status, level of fracture, severity of injury, patient age and comorbidities. Predicting neurological improvement in patients with traumatic spinal cord injuries (SCIs is very difficult because it is related to different preoperative prognostic factors. We evaluated the neurological improvement related to the preoperative neurological conditions and the anatomic level of spinal cord injury. Methods: From January 2004 to June 2010, we operated 207 patients for unstable thoracolumbar spinal fractures. We carried out a retrospective analysis of 69 patients with traumatic SCIs operated on by a posterior fixation performed within 24 hours from the trauma. The preoperative neurological conditions (ASIA grade, the type of the fracture, the anatomic level of spinal cord injury and the postoperative neurological improvement were evaluated for each patient. Results: The ASIA grade at admission (P = 0,0005, the fracture type according to the AO spine classification (P = 0,0002, and the anatomic location of the injury (P = 0,0213 represented predictive factors of neurological improvement at univariate analysis. The preoperative neurological status (P = 0,0491 and the fracture type (P = 0,049 confirmed a positive predictive value also in the multivariate analysis. Conclusions : Our study confirms that the preoperative neurological status, the fracture type and the anatomic location of the fracture are predictive factors of the neurological outcome in patients with spinal cord injury.

  18. Neurological outcome in a series of 58 patients operated for traumatic thoracolumbar spinal cord injuries

    Science.gov (United States)

    Dobran, Mauro; Iacoangeli, Maurizio; Di Somma, Lucia Giovanna Maria; Di Rienzo, A.; Colasanti, Roberto; Nocchi, Niccolò; Alvaro, Lorenzo; Moriconi, Elisa; Nasi, Davide; Scerrati, Massimo

    2014-01-01

    Background: Traumatic thoracolumbar spinal fractures represent approximately 65% of all traumatic spinal fractures and are frequently associated to permanent disability with significant social and economic impact. These injuries create severe physical limitations depending on neurological status, level of fracture, severity of injury, patient age and comorbidities. Predicting neurological improvement in patients with traumatic spinal cord injuries (SCIs) is very difficult because it is related to different preoperative prognostic factors. We evaluated the neurological improvement related to the preoperative neurological conditions and the anatomic level of spinal cord injury. Methods: From January 2004 to June 2010, we operated 207 patients for unstable thoracolumbar spinal fractures. We carried out a retrospective analysis of 69 patients with traumatic SCIs operated on by a posterior fixation performed within 24 hours from the trauma. The preoperative neurological conditions (ASIA grade), the type of the fracture, the anatomic level of spinal cord injury and the postoperative neurological improvement were evaluated for each patient. Results: The ASIA grade at admission (P = 0,0005), the fracture type according to the AO spine classification (P = 0,0002), and the anatomic location of the injury (P = 0,0213) represented predictive factors of neurological improvement at univariate analysis. The preoperative neurological status (P = 0,0491) and the fracture type (P = 0,049) confirmed a positive predictive value also in the multivariate analysis. Conclusions: Our study confirms that the preoperative neurological status, the fracture type and the anatomic location of the fracture are predictive factors of the neurological outcome in patients with spinal cord injury. PMID:25289154

  19. Urinary tract stone in patients with spinal cord injury: a retrospective radiological study

    Energy Technology Data Exchange (ETDEWEB)

    Yun, Eun Joo; Lee, Jong Koo; Shin, Hyun Ja [Korea Veterans Hospital, Seoul (Korea, Republic of)

    1995-01-15

    To compare the incidence between author's first and current report on urinary tract stone in patient with spinal cord injury and to evaluate the effectiveness of recent developed in medical technology and care on in treating the patients. We reviewed urinary tract stone in 257 patients with paraplegia or quadriplegia after spinal cord injury. These patients were diagnosed retrospectively by KUB and intravenous urography at the Korea Veterans Hospital during 10 years from January, 1984 to December, 1993. We evaluated and compared the overall incidence, incidence of specific location of urinary tract, recurrent rate, incidence according to the level of spinal cord injury, and the duration of development in urinary tract stone. Total patients were 257 with 186 (72.4%) paraplegia and 71 (27.6%) quadriplegia. Overall incidence of the stone was 16.0% in this study and 38.1% in the first study. Incidence of the stone in individual organ; 5.5% in kidney, 1.2% in ureter, and 13.6% in urinary bladder. The recurrent rate was 29.3% in this study and 40.6% in the first study. Incidence of the stone according to the level of spinal cord injury was as follows; 15.6% in cervix, 17.1% in upper thorax, 17.9% in lower thorax and 13.9% in lumbar. The stone developed during the first 4 years and between 12 to 16 years following spinal cord injury was 28.3% each. Overall incidence and recurrent rate of urinary tract stone was obviously decreased since the first study. Highest incidence of the stone occurred in urinary bladder and in patient with lower thoracic spinal cord injury, which is similar to first report. Peak incidence of the stone was in the first 4 years, and another peak was in 12-16 years after spinal cord injury. The decreased overall incidence of urinary tract stone maybe attributable to the development in medical technology and care, and active rehabilitation.

  20. Benefits of rehabilitation for traumatic spinal cord injury. Multivariate analysis in 711 patients.

    Science.gov (United States)

    Yarkony, G M; Roth, E J; Heinemann, A W; Wu, Y C; Katz, R T; Lovell, L

    1987-01-01

    The functional outcomes of 711 patients with traumatic spinal cord injuries who were admitted to a rehabilitation hospital during an eight-year period were studied. The modified Barthel index, a 100-point scale, was used to assess ability to perform self-care and mobility skills at rehabilitation admission and discharge. There were statistically significant improvements in self-care and mobility subscores of the modified Barthel index. Mean total modified Barthel index scores increased from 13.8 at admission to 46.1 at discharge for patients with quadriplegia, and from 37.7 to 74.4 for patients with paraplegia. Functional gains made by patients with incomplete spinal lesions were greater than those made by patients with complete lesions. This study documents improvement in ability to perform self-care and mobility skills among patients with spinal cord injuries who participate in comprehensive rehabilitation.

  1. Scales on Quality of Life in patients with spinal cord injury: integrative review.

    Science.gov (United States)

    Aquarone, Rita Lacerda; Faro, Ana Cristina Mancussi e

    2014-04-01

    Studies evaluating the Quality of Life of individuals with spinal cord injury using different research tools demonstrate that the Quality of Life scores are considered low both in national and international studies. The objective of this review was to characterize the international scientific production about the most used scales to assess Quality of Life in patients with spinal cord injury. We examined articles on Quality of Life of patients with spinal cord injury published over the last 5 years and indexed in the National Library of Medicine (PUBMED). During this period, 28 articles met the inclusion criteria. Eleven studies were conducted in the United States, five articles were published in Australia, and four in Canada. Brazil, France, Holland, India, Japan, Norway, Singapore and Switzerland contributed with one study each. The scientific articles were published in 13 high impact factor journals. Seven different instruments to assess Quality of Life were used in the studies: Satisfaction with Life Scale, Short Form (36) Health Survey, The Brief Version of the WHO Quality of Life Questionnaire (WHOQOL-BREF), Comprehensive Quality of Life Scale, Life Situation Questionnaire-Revised, Quality of Well-Being Scale and the SF-12® Health Survey. The articles examined underscore the impact of spinal cord injury in the Quality of Life of patients, demonstrating how this condition impairs their lives, mainly socially, but followed by the physical aspects. Despite the studies have different goals they all acknowledge that further studies are necessary in order to determine the Quality of Life of patients with spinal cord injury. Specific instruments should be chosen or developed and validated in order to fulfill this purpose.

  2. Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: Risk factors and management

    Science.gov (United States)

    Shaikh, Nissar; Rhaman, M. A.; Raza, Ali; Shabana, Adel; Malstrom, Mahommad Faisal; Al-Sulaiti, Ghanem

    2016-01-01

    Background: High spinal cord injury (HSCI) is one of the devastating traumatic injuries. 80% of these patients are young male, and 93% will have major neurological disabilities. There is a paucity of literature about prolonged bradycardia in HSCI patients. The aim of this study was to know the prevalence, risk factors, precipitating factors for prolonged bradycardia in the HSCI patients. Materials and Methods: All patients who were admitted to the Intensive Care Unit (ICU) of a tertiary hospital, with spinal cord injury above level of dorsal (D4) were enrolled in this study prospectively. Patient's demographic data, mechanism, level and type of spinal injury, associated injuries, injury severity score (ISS), spinal shock, vasopressors used, time of occurrence of bradycardia, treatment for bradycardia, precipitating as well as risk factors and outcome were recorded. Results: During the study period, a total of 138 patients were admitted to the ICU with HSCI. Majority of patients were male. The most frequently associated injury in these patients was skeletal fractures (38.4%). Most common complication was pneumonia 56 (41%). Forty-five (33%) of the total patients had prolonged bradycardia; 87% of these patients had pneumonia when bradycardia occurred. 53.4% had cardiac asystole. 29 (21%) patients had bradycardia at the time of endotracheal suctioning, whereas 27 (20%) patients developed bradycardia at the time of positioning. Majority of the patients were managed conservatively. Those HSCI patients who developed prolonged bradycardia, their ISS score was statistically higher, ICU and hospital stay was significantly higher compared with those HSCI patient who did not have prolonged bradycardia. Multivariate analysis revealed that hypotension on admission; pneumonia, and tracheostomy were risk factors for the development of prolonged bradycardia in HSCI patients. Conclusion: Prolonged bradycardia was associated with significantly higher incidence of asystole

  3. Care of post-traumatic spinal cord injury patients in India: An analysis

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    Pandey V

    2007-01-01

    Full Text Available Background: The spinal cord injured patients if congregated early in spinal units where better facilities and dedicated expert care exist the outcome of treatment and rehabilitation, can be improved. The objective of this study is to find out the various factors responsible for a delay in the presentation of spinal injury patients to the specialized spinal trauma units and to suggest steps to improve the quality of care of the spinal trauma patients in the Indian setup. Materials and Methods: Sixty patients of traumatic spinal cord injury admitted for rehabilitation between August 2005 and May 2006 were enrolled into the study and their data was analyzed. Results: Eighty-five per cent of the spinal cord injured patients were males and the mean age was 34 years (range 13-56 years. Twenty-nine (48.33% of the spinal injuries occurred due to fall from height. There was an average of 45 days (range 0-188 days of delay in presentation to a specialized spinal unit and most of the time the cause for the delay was unawareness on the part of patients and/or doctors regarding specialized spinal units. In 38 (62.5% cases the mode of transportation of the spinal cord injured patient to the first visited hospital was by their own conveyance and the attendants of the patients did not have any idea about precautions essential to prevent neurological deterioration. Seventeen (28.33% patients were given injection solumedrol with conservative treatment, 35 (60% patients were given only conservative treatment and seven patients were operated (11.66% upon at initially visited hospital. Of the seven patients operated five were fixed with posterior Harrington instrumentation (71.42% and two (28.57% were operated by short segment posterior pedicle screw fixation. None of the patients were subjected to physiotherapy-assisted transfers or wheel chair skills or even basic postural training, proper bladder/ bowel training program and sitting balance. Conclusion: Awareness

  4. Evolution of traumatic spinal cord injury in patients with ankylosing spondylitis, in a Romanian rehabilitation clinic

    OpenAIRE

    Anghelescu, Aurelian; Onose, Liliana Valentina; Popescu, Cristina; Andone, Ioana; Daia, Cristina Octaviana; Magdoiu, Anca Magdalena; Spanu, Aura; Onose, Gelu

    2016-01-01

    The ankylosing spondylitis (AS) is a systemic, multi-factorial, chronic rheumatic disease. Patients are highly susceptible to vertebral fractures with or without spinal cord injury (AS-SCI), even after a minor trauma. The study is a retrospective descriptive survey of post-acute, traumatic AS-SCI patients, transferred from the neurosurgical department and admitted in a Romanian Neurorehabilitation Clinic, during 2010?2014. There were 11 males associating AS-SCI (0.90% of all consecutive SCI a...

  5. Side effects of steroid use in patients with traumatic spinal cord injury

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    Juan Manuel Del Toro Aguayo

    2015-03-01

    Full Text Available OBJECTIVE: Indicate and identify potential complications in our unit associated with the use of steroids in patients over 16 years of age with traumatic acute spinal cord injury managed with NASCIS II, III scheme compared with patients with the same characteristics who did not receive this management. METHODS: To conduct a research study with reports of cases and controls in patients over 16 years of age and with an established diagnosis of acute spinal cord injury, treated definitively in our unit, performing the comparison of evolutionary process between those treated with steroids and those who were not, based on the development of a data collection sheet with several variables.. The results were encoded, tabulated and analyzed. RESULTS: A total of 30 patients were analyzed from January to December 2012 and it was found that 16% of the patients managed with the steroid scheme required admission to the intensive care unit, 40% developed hospital-acquired pneumonia, 17% had urinary tract infection, 3% progressed to respiratory failure and 20% of this group had gastrointestinal bleeding. CONCLUSIONS: It was concluded that steroid management is not a risk-free therapy and the recommendation is to make a direct assessment of the potential benefit to its use in relation to the possible complications that can ensue before choosing this option in patients with traumatic spinal cord injury.

  6. Effects of theta burst stimulation on referred phantom sensations in patients with spinal cord injury.

    Science.gov (United States)

    Nardone, Raffaele; De Blasi, Pierpaolo; Höller, Yvonne; Taylor, Alexandra C; Brigo, Francesco; Trinka, Eugen

    2016-03-02

    To further explore the mechanisms underlying cortical reorganization in patients with phantom sensations after deafferentation, a repetitive transcranial magnetic stimulation study was carried out in two patients with referred phantom sensations (RPS) after incomplete spinal cord injury at the thoracic level. We delivered continuous (inhibitory), intermittent (excitatory), and placebo theta burst stimulation to the contralateral primary motor cortex (M1), primary somatosensory cortex (S1), and secondary somatosensory cortex (S2). Perception of RPS was significantly and transiently disrupted by inhibitory theta burst stimulation applied over S1 and, to a lesser extent, S2. This study supports the hypothesis that RPS depend on remapping in the somatosensory cortex and provides further electrophysiological evidence in vivo that cortical reorganizational processes are critically modulated by GABAergic mechanisms. Enhancement of GABAergic activity may block cortical reorganization, leading to RPS in spinal cord injury patients.

  7. Virtual reality in rehabilitation: WIITM as an occupational therapy tool in patients with spinal cord injuries

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    Fundación del Lesionado Medular

    2014-10-01

    Full Text Available The use of virtual reality has gained importance in the rehabilitation sector over the last few years. The Wii™ console complements traditional treatment by exercising the motor skills in a motivating context, which is important in long-term interventions, such as spinal cord injury. Objectives: to describe our work with the Wii™ console and the different support products used in occupational therapy at the Fundación del Lesionado Medular, and to discuss advantages and disadvantages. Method: 63 patients with spinal cord injury (of whom 46 with quadriplegia and 17 with paraplegia, treated over the period of one year in weekly 30-minute sessions. Results: motor-skill improvements, more involvement of the patients in the treatment. Conclusion: the features of the console and the support products created by our department make the Wii™ accessible to patients, increase their motivation and enrich the treatment.

  8. Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction

    Institute of Scientific and Technical Information of China (English)

    Zuhal Ozisler; Kurtulus Koklu; Sumru Ozel; Sibel Unsal-Delialioglu

    2015-01-01

    In this study, we aimed to determine gastrointestinal problems associated with neurogenic bowel dysfunction in spinal cord injury patients and to assess the efifcacy of bowel program on gas-trointestinal problems and the severity of neurogenic bowel dysfunction. Fifty-ifve spinal cord injury patients were included in this study. A bowel program according to the characteristics of neurogenic bowel dysfunction was performed for each patient. Before and after bowel program, gastrointestinal problems (constipation, dififcult intestinal evacuation, incontinence, abdominal pain, abdominal distension, loss of appetite, hemorrhoids, rectal bleeding and gastrointestinal induced autonomic dysrelfexia) and bowel evacuation methods (digital stimulation, oral med-ication, suppositories, abdominal massage, Valsalva maneuver and manual evacuation) were determined. Neurogenic bowel dysfunction score was used to assess the severity of neurogenic bowel dysfunction. At least one gastrointestinal problem was identiifed in 44 (80%) of the 55 patients before bowel program. Constipation (56%, 31/55) and incontinence (42%, 23/55) were the most common gastrointestinal problems. Digital rectal stimulation was the most common method for bowel evacuation, both before (76%, 42/55) and after (73%, 40/55) bowel program. Oral medication, enema and manual evacuation application rates were signiifcantly decreased and constipation, dififcult intestinal evacuation, abdominal distention, and abdominal pain rates were signiifcantly reduced after bowel program. In addition, mean neurogenic bowel dysfunction score was decreased after bowel program. An effective bowel program decreases the severity of neurogenic bowel dysfunction and reduces associated gastrointestinal problems in patients with spinal cord injury.

  9. Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction

    Directory of Open Access Journals (Sweden)

    Zuhal Ozisler

    2015-01-01

    Full Text Available In this study, we aimed to determine gastrointestinal problems associated with neurogenic bowel dysfunction in spinal cord injury patients and to assess the efficacy of bowel program on gastrointestinal problems and the severity of neurogenic bowel dysfunction. Fifty-five spinal cord injury patients were included in this study. A bowel program according to the characteristics of neurogenic bowel dysfunction was performed for each patient. Before and after bowel program, gastrointestinal problems (constipation, difficult intestinal evacuation, incontinence, abdominal pain, abdominal distension, loss of appetite, hemorrhoids, rectal bleeding and gastrointestinal induced autonomic dysreflexia and bowel evacuation methods (digital stimulation, oral medication, suppositories, abdominal massage, Valsalva maneuver and manual evacuation were determined. Neurogenic bowel dysfunction score was used to assess the severity of neurogenic bowel dysfunction. At least one gastrointestinal problem was identified in 44 (80% of the 55 patients before bowel program. Constipation (56%, 31/55 and incontinence (42%, 23/55 were the most common gastrointestinal problems. Digital rectal stimulation was the most common method for bowel evacuation, both before (76%, 42/55 and after (73%, 40/55 bowel program. Oral medication, enema and manual evacuation application rates were significantly decreased and constipation, difficult intestinal evacuation, abdominal distention, and abdominal pain rates were significantly reduced after bowel program. In addition, mean neurogenic bowel dysfunction score was decreased after bowel program. An effective bowel program decreases the severity of neurogenic bowel dysfunction and reduces associated gastrointestinal problems in patients with spinal cord injury.

  10. Acute rehabilitation of spinal cord injury

    OpenAIRE

    KIDRIČ-SIVEC, Urška; SEDEJ, Bogdana; MAROLT, Melita

    2015-01-01

    Traumatic spinal cord injury presents with loss of function of neuromuscular and other systems below the level of injury. Patients may suffer from minor loss of strength to complete quadriplegia with respiratory distress. All the patients with traumatic spinal cord injury who are admitted and treated in University Medical Centre Ljubljana are evaluated after admission and individualized plan of rehabilitation is made. The neurological level of injury is documented with international standa...

  11. Usability assessment of ASIBOT: a portable robot to aid patients with spinal cord injury.

    Science.gov (United States)

    Jardón, Alberto; Gil, Ángel M; de la Peña, Ana I; Monje, Concepción A; Balaguer, Carlos

    2011-01-01

    The usability concept refers to aspects related to the use of products that are closely linked to the user's degree of satisfaction. Our goal is to present a functional evaluation methodology for assessing the usability of sophisticated technical aids, such as a portable robot for helping disabled patients with severe spinal cord injuries. The specific manipulator used for this task is ASIBOT, a personal assistance robot totally developed by RoboticsLab at the University Carlos III of Madrid. Our purpose is also to improve some aspects of the manipulator according to the user's perception. For our case study, a population of six patients with spinal cord injury is considered. These patients have been suffering spinal cord injuries for a period of time longer than 1 year before the tests are carried out. The methodology followed for the information gathering is based on the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST). Different daily functions, such as drinking, brushing one's teeth and washing one's face, are considered to assess the user's perception when using ASIBOT as a technical aid. The human factor in this procedure is the main base to establish the specific needs and tools to make the end product more suitable and usable.

  12. Activity-specific aquatic therapy targeting gait for a patient with incomplete spinal cord injury.

    Science.gov (United States)

    Wall, Tracy; Falvo, Lisa; Kesten, Adam

    2017-04-01

    Aquatic therapy can lead to improved mobility and health in individuals with various conditions. This case report looks at an activity-specific aquatic therapy targeting gait for a patient with incomplete spinal cord injury (iSCI). The patient participated in an individualized aquatic therapy program two times a week for 6 weeks. Assessment occurred prior to the intervention. There were two follow-up assessments after the intervention. Follow-up assessment 1 was completed within the same week as the final intervention. Follow-up assessment 2 was completed 4 weeks after the first follow-up to assess for carryover. Improvements that met minimal detectable change and minimal clinically important difference were noted in The Walking for Spinal Cord Injury Index-II, Spinal Cord Injury Functional Ambulation Index gait parameters, and gait speed. An activity-specific aquatic therapy program improved gait in a patient with iSCI. The properties of water create a practical environment for safe practice of skills. Further studies are warranted in large samples.

  13. Spinal cord injury drives chronic brain changes

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    Ignacio Jure

    2017-01-01

    Full Text Available Only a few studies have considered changes in brain structures other than sensory and motor cortex after spinal cord injury, although cognitive impairments have been reported in these patients. Spinal cord injury results in chronic brain neuroinflammation with consequent neurodegeneration and cognitive decline in rodents. Regarding the hippocampus, neurogenesis is reduced and reactive gliosis increased. These long-term abnormalities could explain behavioral impairments exhibited in humans patients suffering from spinal cord trauma.

  14. Barriers to and facilitators of coping with spinal cord injury for Iranian patients: a qualitative study.

    Science.gov (United States)

    Babamohamadi, Hassan; Negarandeh, Reza; Dehghan-Nayeri, Nahid

    2011-06-01

    The purpose of the present study was to explore the perspectives and experiences of Iranian patients regarding barriers and facilitators to their ability to cope with spinal cord injury (SCI). A qualitative design, based on the content analysis approach, was used to collect and analyze the experiences of 18 patients with spinal cord injury in two centers in Tehran, Iran. After using purposeful sampling for selection of the participants, semi-structured interviews were held for data collection. Lack of "knowledge", "financial resources", "employment opportunities", "suitable facilities and accessibility" as well as "societal acceptance and support" emerged as barriers; and having "self-confidence", "religious beliefs", "support networks" and "positive thinking" emerged as facilitators in coping with spinal cord injury. Participants believed that with these hindering factors in place, adapting to their new condition had been difficult, therefore they can only manage to adapt partially to their situation. Additional multidisciplinary endeavors are needed to help this group cope adequately and further research is required to influence policy making and legislation processes efficiently. © 2011 Blackwell Publishing Asia Pty Ltd.

  15. Effects of an abdominal binder and electrical stimulation on cough in patients with spinal cord injury.

    Science.gov (United States)

    Lin, K H; Lai, Y L; Wu, H D; Wang, T Q; Wang, Y H

    1998-04-01

    We explored the effect of an abdominal binder, with or without electrical stimulation, on peak expiratory flow rate (PEFR) in 12 paraplegics with complete thoracic cord (T2-T12) injury (mean age 36.0 +/- 1.5 yr) and 12 quadriplegics with complete cervical cord (C4-C8) injury (mean age 36.2 +/- 1.9 yr). The cough was assessed by measuring the PEFR during forceful expiration in a sitting position. The subjects underwent the following experimental maneuvers in a random order with a 10-minute interval between any two maneuvers: 1) voluntary coughing, 2) voluntary coughing with an abdominal binder, and 3) voluntary coughing with an abdominal binder and electrical stimulation. The electrical stimulator (50 Hz with 300 microseconds pulse width) was applied to the abdominal wall. Data were analyzed using multivariate analysis of variance for repeated measures. The abdominal binder did not significantly increase PEFR in either paraplegics or quadriplegics; the abdominal binder combined with electrical stimulation significantly increased PEFR by 15% in the paraplegics and 18% in the quadriplegics. These results indicate that electrical stimulation combined with an abdominal binder improves the cough ability in patients with cervical or thoracic spinal cord injury.

  16. The incomprehensible injury--interpretations of patients' narratives concerning experiences with an acute and dramatic spinal cord injury.

    Science.gov (United States)

    Lohne, Vibeke

    2009-03-01

    Spinal cord injury is one of the most devastating incidents that can occur to an individual as it results in life being suddenly, dramatically, radically and long lastingly changed. Different studies show that a spinal cord injury is a stressful event, leading to physiological dependence, psychological and social illness and suffering, although the situation tends to improve over time. This study is a part of a larger longitudinal study. The aim of this study was to explore and interpret 10 individuals' experiences in connection with their acute and unexpected spinal cord injury. This qualitative study has a descriptive and explorative design and is a part of a larger study. A phenomenological hermeneutic approach inspired by Ricoeur was used to extract the meaningful content of the patients' narratives. In this study, the findings revealed three main themes: (I) 'the incomprehensible shock', (II) 'brave survivors' and (III) 'miracles, luck or coincidences?' The incomprehensible spinal cord injury was often experienced as a dramatic and unexpected shock in the middle of a pleasant occasion, and every participant felt immediately overwhelmed by emotional suffering, such as despair and panic, but also anxiety, confusion, sorrow, guilt, shame, fear, aggression or depression at the moment of injury. Some individuals immediately understood that they had become completely paralysed and that something was seriously wrong with their body. Many also experienced guilt or shame because of choices or decisions made immediately before the injury. Several of the narratives were illuminating participants that had been brave survivors and heroes and saved others (passengers or friends) during the injury, by preventing the car form driving out or by softening the fall of co-passengers, which also entailed more serious injuries to themselves. However, the fact of having survived was experienced as 'being lucky, after all'. They all repeatedly reflected on the accident, and their

  17. Effect of Laser Acupuncture on Heart Rate Variability of Nonpatients and Patients with Spinal Cord Injury

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    Yiu Ming Wong

    2017-02-01

    Full Text Available Sensory loss in a complete spinal cord injury (SCI can be described as an injury that removes the ability of the brain to receive electrical afferent signals generated below the site of the injury. The sensory nervous system appears to be the same as the meridians in the concept of Oriental medicine, thus, we assumed that a complete SCI would lead to discontinuation of the meridians in humans. In this case series report with a cross-sectional view, we observed quantitative changes in heart rate variability induced by laser acupuncture at bilateral GB34 and ST36 points for 15 minutes in eight patients with complete SCIs between the levels of T8 and T12, and eight healthy individuals as a control group. A comparison between pre- and post-treatment data demonstrated that the physiological effect on the heart rate variability was absent when the laser acupuncture was applied below the level of injury among the patients with complete SCI, while the healthy counterparts showed the opposite pattern. The preliminary data suggest that the purported meridian system may not be different from the known sensory nervous system, as the transected spinal cord leads to interrupted meridians. The findings in the present case series warranted further investigation.

  18. The Initial Systolic Time Interval in patients with spinal cord injury measured with impedance cardiography

    Science.gov (United States)

    Hoekstra, Femke; Martinsen, Ørjan G.; Verdaasdonk, Rudolf M.; Janssen, Thomas W. J.; Meijer, Jan H.

    2012-12-01

    The Initial Systolic Time Interval (ISTI), obtained from the electrocardiogram and impedance cardiogram, is considered to be a measure for the time delay between the electrical and mechanical activity of the heart. This time delay is influenced by the sympathetic nerve system. Therefore, an observational study was performed in a group of patients (SCI) with spinal cord injuries. The relationship between the ISTI and the total heart cycle (RR-interval) was established by varying the RR-interval using an exercise stimulus to increase the heart rate. The slope of this relationship was observed to be significantly higher in the SCI-group as compared with a control group, although there was no difference in ISTI in the range of common heart rates during the test between the groups. This slope and the ISTI was observed to be significantly different in an acute patient having a recent spinal cord injury at a high level. Because of the variety in injury levels and incompleteness of the injuries further, more specific research is necessary to draw decisive conclusions with respect to the contribution of autonomic nervous control on the ISTI in SCI, although the present observations are notable.

  19. Patient-focused goal planning process and outcome after spinal cord injury rehabilitation: quantitative and qualitative audit.

    Science.gov (United States)

    Byrnes, Michelle; Beilby, Janet; Ray, Patricia; McLennan, Renee; Ker, John; Schug, Stephan

    2012-12-01

    To evaluate the process and outcome of a multidisciplinary inpatient goal planning rehabilitation programme on physical, social and psychological functioning for patients with spinal cord injury. Clinical audit: quantitative and qualitative analyses. Specialist spinal injury unit, Perth, Australia. Consecutive series of 100 newly injured spinal cord injury inpatients. MAIN MEASURE(S): The Needs Assessment Checklist (NAC), patient-focused goal planning questionnaire and goal planning progress form. The clinical audit of 100 spinal cord injured patients revealed that 547 goal planning meetings were held with 8531 goals stipulated in total. Seventy-five per cent of the goals set at the first goal planning meeting were achieved by the second meeting and the rate of goal achievements at subsequent goal planning meetings dropped to 56%. Based on quantitative analysis of physical, social and psychological functioning, the 100 spinal cord injury patients improved significantly from baseline to discharge. Furthermore, qualitative analysis revealed benefits consistently reported by spinal cord injury patients of the goal planning rehabilitation programme in improvements to their physical, social and psychological adjustment to injury. The findings of this clinical audit underpin the need for patient-focused goal planning rehabilitation programmes which are tailored to the individual's needs and involve a comprehensive multidisciplinary team.

  20. Evaluation of an occupational therapy program for patients with spinal cord injury.

    Science.gov (United States)

    Pillastrini, P; Mugnai, R; Bonfiglioli, R; Curti, S; Mattioli, S; Maioli, M G; Bazzocchi, G; Menarini, M; Vannini, R; Violante, F S

    2008-01-01

    Clinical controlled trial. To evaluate the effectiveness of an occupational therapy (OT) program combined with neuromotor rehabilitation, by assessing the degree of functional independence reached by patients with spinal cord injuries at first hospitalization. Subjects selected from the Spinal Cord Unit of the Rehabilitation Institute of Montecatone (Imola, Italy). Thirty-six male patients below age 60, with complete paraplegia (ASIA-A) in thoracic-lumbar level, at first hospitalization. Patients were divided into experimental and control groups. Subjects in the experimental group underwent neuromotor rehabilitation coupled with an OT program, whereas those in the control group followed neuromotor rehabilitation only. Increase in functional independence at discharge was evaluated by the Valutazione Funzionale Mielolesi (VFM) assessment scale. Patients in the experimental group showed a significant increase in the total VFM score, and in domains concerning transfers and wheelchair use. A significant improvement was observed in unmarried patients as compared to married ones. An OT service within a Spinal Cord Unit allows us to achieve a higher level of functional independence.

  1. Iatrogenic Spinal Cord Injury in a Trauma Patient with Ankylosing Spondylitis.

    Science.gov (United States)

    Maarouf, Ahmad; McQuown, Colleen M; Frey, Jennifer A; Ahmed, Rami A; Derrick, Lisa

    2017-01-01

    The recommended practice for over 30 years has been to routinely immobilize patients with unstable cervical spinal injuries using cervical spinal collars. It is shown that patients with Ankylosing spondylitis (AS) are four times more likely to suffer a spinal fracture compared to the general population and have an eleven-fold greater risk of spinal cord injury. Current protocols of spinal immobilization were responsible for secondary neurologic deterioration in some of these patients. To describe an iatrogenic injury resulting from the use of a rigid spinal board and advocate for the use of alternative immobilization methods or no immobilization at all. We present our case here of a 68-year-old male with a history of AS. The patient was ambulatory on scene after a low speed car accident, but immobilized with a rigid backboard by paramedics. He developed back pain and paraplegia suddenly when the backboard was lifted for transport to the hospital. A CT scan revealed an extension fraction of T10 to T11 with involvement of the posterior column. Emergency spinal fusion was performed. Patient died of complications in the hospital. This case shows that spinal immobilization should be avoided in cases of ambulatory patients without a clear indication. Alternative transport methods such as vacuum mattresses should be considered when spinal immobilization is indicated, especially for patients with predispositions to spinal injury, particularly AS, to maintain the natural alignment of the spinal curvature.

  2. Health and economic benefits of physical activity for patients with spinal cord injury

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    Miller LE

    2016-10-01

    Full Text Available Larry E Miller,1 William G Herbert1,2 1Miller Scientific Consulting, Inc., Asheville, NC, 2Department of Human Nutrition, Foods & Exercise, Virginia Tech, Blacksburg, VA, USA Abstract: Spinal cord injury (SCI is a traumatic, life-disrupting event with an annual incidence of 17,000 cases in the US. SCI is characterized by progressive physical deconditioning due to limited mobility and lack of modalities to allow safe physical activity that may partially offset these deleterious physical changes. Approximately, 50% of patients with SCI report no leisure-time physical activity and 15% report leisure-time physical activity below the threshold where meaningful health benefits could be realized. Collectively, about 363,000 patients with SCI, or 65% of the entire spinal cord injured population in the US, engages in insufficient physical activity and represents a target population that could derive considerable health benefits from even modest physical activity levels. Currently, the annual direct costs related to SCI exceed US$45 billion in the US. Rehabilitation protocols and technologies aimed to improve functional mobility have potential to significantly reduce the risk of medical complications and cost associated with SCI. Patients who commence routine physical activity in the first post-injury year and experience typical motor function improvements would realize US$290,000 to US$435,000 in lifetime cost savings, primarily due to fewer hospitalizations and less reliance on assistive care. New assistive technologies that allow patients with SCI to safely engage in routine physical activity are desperately needed. Keywords: ambulation, cost, exercise, exoskeleton, paraplegia, physical activity, spinal cord injury

  3. Localised necrosis of scrotum (Fournier's gangrene in a spinal cord injury patient – a case report

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    Singh Gurpreet

    2002-12-01

    Full Text Available Abstract Background Men with spinal cord injury (SCI appear to have a greater incidence of bacterial colonisation of genital skin as compared to neurologically normal controls. We report a male patient with paraplegia who developed rapidly progressive infection of scrotal skin, which resulted in localised necrosis of scrotum (Fournier's gangrene. Case presentation This male patient developed paraplegia at T-8 level 21 years ago at the age of fifteen years. He has been managing his bladder by wearing a penile sheath. He noticed redness and swelling on the right side of the scrotum, which rapidly progressed to become a black patch. A wound swab yielded growth of methicillin-resistant Staphylococcus aureus (MRSA. Necrotic tissue was excised. Culture of excised tissue grew MRSA. A follow-up wound swab yielded growth of MRSA and mixed anaerobes. The wound was treated with regular application of povidone-iodine spray. He made good progress, with the wound healing gradually. Conclusion It is likely that the presence of a condom catheter, increased skin moisture in the scrotum due to urine leakage, compromised personal hygiene, a neurogenic bowel and subtle dysfunction of the immune system contributed to colonisation, and then rapidly progressive infection in this patient. We believe that spinal cord injury patients and their carers should be made aware of possible increased susceptibility of SCI patients to opportunistic infections of the skin. Increased awareness will facilitate prompt recourse to medical advice, when early signs of infection are present.

  4. Ambulation and spinal cord injury.

    Science.gov (United States)

    Hardin, Elizabeth C; Kobetic, Rudi; Triolo, Ronald J

    2013-05-01

    Walking is possible for many patients with a spinal cord injury. Avenues enabling walking include braces, robotics and FES. Among the benefits are improved musculoskeletal and mental health, however unrealistic expectations may lead to negative changes in quality of life. Use rigorous assessment standards to gauge the improvement of walking during the rehabilitation process, but also yearly. Continued walking after discharge may be limited by challenges, such as lack of accessibility in and outside the home, and complications, such as shoulder pain or injuries from falls. It is critical to determine the risks and benefits of walking for each patient.

  5. Spinal cord injury in patients with ankylosing spondylitis: a 10-year review.

    Science.gov (United States)

    Thumbikat, Pradeep; Hariharan, Ramaswamy P; Ravichandran, Ganapathiraju; McClelland, Martin R; Mathew, Kidangalil M

    2007-12-15

    Retrospective study. To evaluate the clinical and functional outcomes in patients with spinal cord injury (SCI) and preexisting ankylosing spondylitis (AS). AS alters the strength and biomechanical properties of the spine that renders it susceptible to fracture with minimal trauma. Neurologic involvement is common and outcomes largely depend on the early recognition and appropriate management. A 10-year review (1996-2005) was carried out to identify all patients admitted with SCI associated with AS. The cause of injury, prehospital and emergency management, definitive treatment of fracture, final neurology, and functional outcomes were ascertained. Reasons for neurologic deterioration were determined. Eighteen patients were identified. In 15 patients, the injury resulted from trauma (fall 14, road accident 1) and in 3 the SCI followed spinal surgical interventions. Twelve of the 15 patients with traumatic injuries were able to walk immediately after the fall but subsequently deteriorated for various reasons. Spinal epidural hematomas developed in 3 patients (2 traumatic, 1 spinal intervention). The fractures were managed surgically in 3 patients, halo jacket was used in 2, and the remainder were managed expectantly on traction. Four patients died before discharge, 4 were able to walk with an aid at discharge, and the others were wheel chair dependent. Neurologic deficits were often subtle on initial presentation, resulting in many injuries being missed because of a low index of suspicion and poor visualization of lower cervical fractures on conventional radiographs. Extension of the ankylosed kyphotic cervical spine during conventional immobilization or for radiologic procedures resulted in neurologic deficits. Patients with an ankylosed cervical spine are normally unable to see the ceiling lying supine because of cervicothoracic kyphosis and use pillows to support their head. Cervical spine alignment in a similar flexed position is essential during immobilization

  6. Long-term result of Memokath urethral sphincter stent in spinal cord injury patients

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    Sett Pradipkumar

    2002-11-01

    Full Text Available Abstract Background Memokath urethral sphincter stents are used to facilitate bladder emptying in patients with spinal cord injury, but long term follow-up has not been reported. Methods Case series of ten men with spinal cord injury who underwent insertion of Memokath stents and were followed for up to nine years. Results Within four years, the stent had to be removed in nine out of ten patients because of: extensive mucosal proliferation causing obstruction to the lumen of the stent; stone around the proximal end of the stent, incomplete bladder emptying, and recurrent urinary infections; migration of the stent into the bladder related to digital evacuation of bowels; large residual urine; concretions within the stent causing obstruction to flow of urine, and partial blockage of the stent causing frequent episodes of autonomic dysreflexia. In one patient the stent continued to function satisfactorily after nine years. Conclusions The Memokath stent has a role as a temporary measure for treatment of detrusor-sphincter dyssynergia in selected SCI patients who do not get recurrent urinary infection and do not require manual evacuation of bowels.

  7. Neurogenic bowel dysfunction in patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson's disease

    Institute of Scientific and Technical Information of China (English)

    Richard A Awad

    2011-01-01

    Exciting new features have been described concerning neurogenic bowel dysfunction, including interactions between the central nervous system, the enteric nervous system, axonal injury, neuronal loss, neurotransmission of noxious and non-noxious stimuli, and the fields of gastroenterology and neurology. Patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson's disease present with serious upper and lower bowel dysfunctions characterized by constipation, incontinence, gastrointestinal motor dysfunction and altered visceral sensitivity. Spinal cord injury is associated with severe autonomic dysfunction, and bowel dysfunction is a major physical and psychological burden for these patients. An adult myelomeningocele patient commonly has multiple problems reflecting the multisystemic nature of the disease. Multiple sclerosis is a neurodegenerative disorder in which axonal injury, neuronal loss, and atrophy of the central nervous system can lead to permanent neurological damage and clinical disability. Parkinson's disease is a multisystem disorder involving dopaminergic, noradrenergic, serotoninergic and cholinergic systems, characterized by motor and non-motor symptoms. Parkinson's disease affects several neuronal structures outside the substantia nigra, among which is the enteric nervous system. Recent reports have shown that the lesions in the enteric nervous system occur in very early stages of the disease, even before the involvement of the central nervous system. This has led to the postulation that the enteric nervous system could be critical in the pathophysiology of Parkinson's disease, as it could represent the point of entry for a putative environmental factor to initiate the pathological process. This review covers the data related to the etiology, epidemiology, clinical expression, pathophysiology, genetic aspects, gastrointestinal motor dysfunction, visceral sensitivity, management, prevention and prognosis of neurogenic bowel

  8. Factors affecting the length of stay of patients with traumatic spinal cord injury in Tianjin, China

    Science.gov (United States)

    Wu, Qiang; Ning, Guang-Zhi; Li, Yu-Lin; Feng, Hong-Yong; Feng, Shi-Qing

    2013-01-01

    Purpose To describe the acute care length of stay (ACLOS) of adult patients with traumatic spinal cord injury (TSCI) in Tianjin, China, and identify the associated demographic and clinical factors. Methods TSCI patients admitted to a general hospital in Tianjin, China from 2004 to 2007 were identified. The predictor variables were demographic and clinical factors, including age, gender, etiology, level of injury, severity, associated injuries, surgery, and complications. The outcome variable was ACLOS. Multivariable linear regression analysis models were used to examine the association between predictor and outcome variables. Results This study included 631 TSCI patients. The mean ACLOS was 32.4 ± 37.7 days, with a range of 1–294 days. The median number of hospitalization days was 21 days. Admission to a suburban hospital surgery, urinary infection, poorer functional status, pressure ulcers, and associated injuries were significantly associated with ACLOS. Conclusion This study examined the effect of epidemiological and clinical factors on ACLOS in Tianjin, China. The factors that influenced the ACLOS were different from factors reported in other studies. More studies are needed in China to determine the effect of these factors on ACLOS in TSCI patients and to propose a predictive model. PMID:23809595

  9. The Clinical Study On 1 Case for The sensation of patient with Spinal Cord Injury whose is improved by using sweet BV

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    In-Sun Park

    2009-06-01

    Full Text Available Obejective : Patients with spinal cord injury are increasing in numbers. However, there is no reliable treatment guide in both conventional & complementory medicine. Also, there are not much clinical case of patients with spina cord injury in oriental medical field. We invesigated effect of sweet BV on subacute stage patient with spinal cord injury. Method : 31-year old female patient with spinal cord injury was treated with herb medicine(TID, electro arcupunture (BID, sweet BV injection(QOD , Physical treatment(QD, and conventionalmedicine. Result : We had a satisfactory result with using sweet BV injection. The patient`s ASIA grade improved from 34 to 52. And Frankle classification of the patient shifted from A to B. Conclusion : We reach a conclusion Using Sweet BV improve the sensation of patient with spinal cord injury. And more study about this disease is needed.

  10. Successful Reinnervation of the Diaphragm After Intercostal to Phrenic Nerve Neurotization in Patients With High Spinal Cord Injury.

    Science.gov (United States)

    Nandra, Kulvir S; Harari, Martin; Price, Thea P; Greaney, Patrick J; Weinstein, Michael S

    2017-08-01

    Our objective in this study was to extend diaphragmatic pacing therapy to include paraplegic patients with high cervical spinal cord injuries between C3 and C5. Diaphragmatic pacing has been used in patients experiencing ventilator-dependent respiratory failure due to spinal cord injury as a means to reduce or eliminate the need for mechanical ventilation. However, this technique relies on intact phrenic nerve function. Recently, phrenic nerve reconstruction with intercostal nerve grafting has expanded the indications for diaphragmatic pacing. Our study aimed to evaluate early outcomes and efficacy of intercostal nerve transfer in diaphragmatic pacing. Four ventilator-dependent patients with high cervical spinal cord injuries were selected for this study. Each patient demonstrated absence of phrenic nerve function via external neck stimulation and laparoscopic diaphragm mapping. Each patient underwent intercostal to phrenic nerve grafting with implantation of a phrenic nerve pacer. The patients were followed, and ventilator dependence was reassessed at 1 year postoperatively. Our primary outcome was measured by the amount of time our patients tolerated off the ventilator per day. We found that all 4 patients have tolerated paced breathing independent of mechanical ventilation, with 1 patient achieving 24 hours of tracheostomy collar. From this study, intercostal to phrenic nerve transfer seems to be a promising approach in reducing or eliminating ventilator support in patients with C3 to C5 high spinal cord injury.

  11. Bone And Soft Tissue Changes In Patients With Spinal Cord Injury And Multiple Sclerosis

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    Dionyssiotis Yannis

    2014-12-01

    Full Text Available In patients with spinal cord injury and multiple sclerosis, deterioration of body composition (changes in bone, fat and muscle mass is associated with increased risk for diseases such as coronary artery heart disease, non-insulin dependent diabetes mellitus, lipid metabolism abnormalities, and osteoporotic fractures in these patients. Immobility leads to a changing pattern of loading in the paralyzed areas, and secondary alteration in structure. However, bone and soft tissue changes in these patients are usually neglected. The purpose of this article is to update on the pathophysiological mechanisms leading to bone and soft tissue changes, and to increase the awareness of the treating physicians with respect to bone, muscle and fat loss and their consequences aiming to obtain measures to prevent bone and soft tissue loss in these patients.

  12. Urinary tract infection in patients with spinal cord injury in Bushehr Province

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    Hooman Salimipour

    2005-02-01

    Full Text Available Urinary tract infection (UTI is a common problem in patients with spinal cord injury (SCI. UTI is an important cause of morbidity and mortality among these patients. In a cross-sectional study, 957 cases with SCI were evaluated for UTI. The mean of age of the subjects (35 females & 62 males was 26.74 years and the mean duration of SCI was 8.5 years. The prevalence of UTI was 63.9 percent. The most frequent isolated bacteria was E. coli (71.7% and had susceptibility to ceftizoxime and a high level of resistance to nitrofurantoin. The most common locus of SCI was in lumbosacral area (70.1%. The lumbosacral area was the most prevalent lesion in patients with SCI and UTI. In conclusion, there is a high prevalence of UTI in patients with SCI, therefore intermittent catheterization and the other strategies including using local disinfectants are recommended.

  13. Hepatic injury following reduced intensity unrelated cord blood transplantation for adult patients with hematological diseases.

    Science.gov (United States)

    Kusumi, Eiji; Kami, Masahiro; Kanda, Yoshinobu; Murashige, Naoko; Seki, Kunihiko; Fujiwara, Masayo; Koyama, Rikako; Komatsu, Tsunehiko; Hori, Akiko; Tanaka, Yuji; Yuji, Koichiro; Matsumura, Tomoko; Masuoka, Kazuhiro; Wake, Atsushi; Miyakoshi, Shigesaburo; Taniguchi, Shuichi

    2006-12-01

    Liver injury is a common complication in allogeneic hematopoietic stem cell transplantation. Its major causes comprise graft-versus-host disease (GVHD), infection, and toxicities of preparative regimens and immunosuppressants; however, we have little information on liver injuries after reduced intensity cord blood transplantation (RICBT). We reviewed medical records of 104 recipients who underwent RICBT between March 2002 and May 2004 at Toranomon Hospital. Preparative regimen and GVHD prophylaxis comprised fludarabine/melphalan/total body irradiation and cyclosporine or tacrolimus. We assessed the etiology of liver injuries based on the clinical presentation, laboratory results, comorbid events, and imaging studies in 85 patients who achieved primary engraftment. The severity of liver dysfunction was assessed according to the National Cancer Institute Common Toxicity Criteria version 2.0. Hyperbilirubinemia was graded according to a report by Hogan et al (Blood. 2004;103:78-84). Moderate to very severe liver injuries were observed in 36 patients. Their causes included cholestatic liver disease (CLD) related to GVHD or sepsis (n = 15), GVHD (n = 7), cholangitis lenta (n = 5), and others (n = 9). Median onsets of CLD, GVHD, and cholangitis lenta were days 37, 40, and 22, respectively. Frequencies of grade 3-4 alanine aminotransferase elevation were comparable across the 3 types of hepatic injuries. Serum gamma-glutamil transpeptidase was not elevated in any patients with cholangitis lenta, whereas 27% and 40% of patients with CLD and GVHD, respectively, developed grade 3-4 gamma-glutamil transpeptidase elevation. Multivariate analysis identified 2 risk factors for hyperbilirubinemia; grade II-IV acute GVHD (relative risk, 2.23; 95% confidential interval, 1.11-4.47; P = .024) and blood stream infection (relative risk, 3.77; 95% confidential interval, 1.91-7.44; P = .00013). In conclusion, the present study has demonstrated that the hepatic injuries are significant

  14. Botulinum toxin A in the treatment of spinal cord injury patients with refractory neurogenic detrusor overactivity

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    Ronaldo A. Alvares

    2010-12-01

    Full Text Available PURPOSE: To evaluate the efficacy of botulinum toxin type A injections in the detrusor muscle in patients with spinal cord injury and urinary incontinence due to detrusor overactivity and refractory to anticholinergic agents. MATERIALS AND METHODS: We prospectively evaluated 22 patients with spinal cord injuries, whose bladders were emptied by intermittent catheterization. All patients had detrusor overactivity and urinary incontinence that proved difficult to treat, despite using high doses of two different anticholinergics. The pre-treatment assessment included a complete urodynamic study and ultrasonography of the kidneys and urinary tract. A one-month follow-up was completed with urodynamic evaluation and the clinical response was evaluated through outpatient consultations and telephone contact. RESULTS: After the procedure, the maximum cystometric capacity and the bladder reflex volume increased, whereas the maximum detrusor pressure and compliance decreased. The mean duration of continence was 7 ± 7 months. In 18 patients (81.8%, it was necessary to administer anticholinergics to achieve continence. Five patients (22.7% had indication of reinjection, and augmentation cystoplasty was indicated in 9 patients (40.9%. CONCLUSION: The use of botulinum toxin in the treatment of neurogenic detrusor overactivity refractory to anticholinergics is an option before more invasive treatments, such as augmentation cystoplasty, are attempted. In our study as well as in the literature, there was improvement in most urodynamic parameters. Overall, 40.9% of patients underwent augmentation cystoplasty and 81.8% of patients needed anticholinergic agents to reach urinary continence. Further studies are necessary to improve the procedure and to achieve better clinical results.

  15. Atypical supernumerary phantom limb and phantom limb pain in a patient with spinal cord injury: case report.

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    Choi, Ja Young; Kim, Hyo In; Lee, Kil Chan; Han, Zee-A

    2013-12-01

    Supernumerary phantom limb (SPL) resulting from spinal cord lesions are very rare, with only sporadic and brief descriptions in the literature. Furthermore, the reported cases of SPL typically occurred in neurologically incomplete spinal cord patients. Here, we report a rare case of SPL with phantom limb pain that occurred after traumatic spinal cord injury in a neurologically complete patient. After a traffic accident, a 43-year-old man suffered a complete spinal cord injury with a C6 neurologic level of injury. SPL and associated phantom limb pain occurred 6 days after trauma onset. The patient felt the presence of an additional pair of legs that originated at the hip joints and extended medially, at equal lengths to the paralyzed legs. The intensity of SPL and associated phantom limb pain subsequently decreased after visual-tactile stimulation treatment, in which the patient visually identified the paralyzed limbs and then gently tapped them with a wooden stick. This improvement continued over the 2 months of inpatient treatment at our hospital and the presence of the SPLs was reduced to 20% of the real paralyzed legs. This is the first comprehensive report on SPLs of the lower extremities after neurologically complete spinal cord injury.

  16. Therapeutic approaches for spinal cord injury

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    Alexandre Fogaça Cristante

    2012-10-01

    Full Text Available This study reviews the literature concerning possible therapeutic approaches for spinal cord injury. Spinal cord injury is a disabling and irreversible condition that has high economic and social costs. There are both primary and secondary mechanisms of damage to the spinal cord. The primary lesion is the mechanical injury itself. The secondary lesion results from one or more biochemical and cellular processes that are triggered by the primary lesion. The frustration of health professionals in treating a severe spinal cord injury was described in 1700 BC in an Egyptian surgical papyrus that was translated by Edwin Smith; the papyrus reported spinal fractures as a ''disease that should not be treated.'' Over the last biological or pharmacological treatment method. Science is unraveling the mechanisms of cell protection and neuroregeneration, but clinically, we only provide supportive care for patients with spinal cord injuries. By combining these treatments, researchers attempt to enhance the functional recovery of patients with spinal cord injuries. Advances in the last decade have allowed us to encourage the development of experimental studies in the field of spinal cord regeneration. The combination of several therapeutic strategies should, at minimum, allow for partial functional recoveries for these patients, which could improve their quality of life.

  17. The effect of increased T2 signal intensity in the spinal cord on the injury severity and early neurological recovery in patients with central cord syndrome.

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    Schroeder, Gregory D; Hjelm, Nik; Vaccaro, Alexander R; Weinstein, Michael S; Kepler, Christopher K

    2016-05-01

    OBJECTIVE The aim of this paper was to compare the severity of the initial neurological injury as well as the early changes in the American Spinal Injury Association (ASIA) motor score (AMS) between central cord syndrome (CCS) patients with and without an increased T2 signal intensity in their spinal cord. METHODS Patients with CCS were identified and stratified based on the presence of increased T2 signal intensity in their spinal cord. The severity of the initial neurological injury and the progression of the neurological injury over the 1st week were measured according to the patient's AMS. The effect of age, sex, congenital stenosis, surgery within 24 hours, and surgery in the initial hospitalization on the change in AMS was determined using an analysis of variance. RESULTS Patients with increased signal intensity had a more severe initial neurological injury (AMS 57.6 vs 75.3, respectively, p = 0.01). However, the change in AMS over the 1st week was less severe in patients with an increase in T2 signal intensity (-0.85 vs -4.3, p = 0.07). Analysis of variance did not find that age, sex, Injury Severity Score, congenital stenosis, surgery within 24 hours, or surgery during the initial hospitalization affected the change in AMS. CONCLUSIONS The neurological injury is different between patients with and without an increased T2 signal intensity. Patients with an increased T2 signal intensity are likely to have a more severe initial neurological deficit but will have relatively minimal early neurological deterioration. Comparatively, patients without an increase in the T2 signal intensity will likely have a less severe initial injury but can expect to have a slight decline in neurological function in the 1st week.

  18. Nutrition of People with Spinal Cord Injuries

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    This conference proceeding summarizes current knowledge about the nutritional status and needs of the spinal cord injured patient. Topics covered include the aspects of spinal cord injury that influence nutrient intakes and status, and the nutrients most likely to be problematic in this diverse gro...

  19. Pain following spinal cord injury

    OpenAIRE

    2004-01-01

    The aims of this thesis were to assess and characterise nociceptive and neuropathic pain, the use of pharmacological and non-pharmacological pain treatment, and the influence of pain on the quality of sleep in a population following spinal cord injury (SCI). This thesis is divided into five separate studies: I. Pain in a Swedish spinal cord injury population. II. Gender related differences in pain in spinal cord injured individuals. III. Use of analgesic drugs in indi...

  20. Evolution of traumatic spinal cord injury in patients with ankylosing spondylitis, in a Romanian rehabilitation clinic.

    Science.gov (United States)

    Anghelescu, Aurelian; Onose, Liliana Valentina; Popescu, Cristina; Andone, Ioana; Daia, Cristina Octaviana; Magdoiu, Anca Magdalena; Spanu, Aura; Onose, Gelu

    2016-01-01

    The ankylosing spondylitis (AS) is a systemic, multi-factorial, chronic rheumatic disease. Patients are highly susceptible to vertebral fractures with or without spinal cord injury (AS-SCI), even after a minor trauma. The study is a retrospective descriptive survey of post-acute, traumatic AS-SCI patients, transferred from the neurosurgical department and admitted in a Romanian Neurorehabilitation Clinic, during 2010-2014. There were 11 males associating AS-SCI (0.90% of all consecutive SCI admitted cases), with an average age of 54.6 years (median 56, limits 42-73 years). The average duration between the medically diagnosed AS and the actual associated spinal fracture(-s) moment was 21.4 years (median 23; limits 10-34 years). Low-energy trauma was incriminated in 54.5% cases. The spinal level of fracture was: cervical (four cases), thoracic (three), lumbar (four), assessed at admission as: American Spinal Injury Association (ASIA) Impairment Scale (AIS) A (four subjects), C (five) and D (two). By the time of discharge, neither patient has neurologically deteriorated; five patients (45.5%) improved of at least grade 1 (AIS). The overall complications were mainly infections: symptomatic urinary tract infections (seven patients; 63.6%), pulmonary (three subjects; 27.3%) and spondylodiscitis (one case; 9%). The average follow-up period was 15.3 months (median 12; limits 1-48 months) after discharge; three subjects gained functional improvement to AIS-E. The clinical profile (different risk factors, mechanisms, types and levels of spinal fractures, additional encephalic and/or cord lesions, co-morbidities), different post-surgical and/or general complications acquired during admission in our rehabilitation ward, served us for future prevention strategies and a better therapeutic management.

  1. Long-term paired associative stimulation can restore voluntary control over paralyzed muscles in incomplete chronic spinal cord injury patients.

    Science.gov (United States)

    Shulga, Anastasia; Lioumis, Pantelis; Zubareva, Aleksandra; Brandstack, Nina; Kuusela, Linda; Kirveskari, Erika; Savolainen, Sarianna; Ylinen, Aarne; Mäkelä, Jyrki P

    2016-01-01

    Emerging therapeutic strategies for spinal cord injury aim at sparing or restoring at least part of the corticospinal tract at the acute stage. Hence, approaches that strengthen the weak connections that are spared or restored are crucial. Transient plastic changes in the human corticospinal tract can be induced through paired associative stimulation, a noninvasive technique in which transcranial magnetic brain stimulation is synchronized with electrical peripheral nerve stimulation. A single paired associative stimulation session can induce transient plasticity in spinal cord injury patients. It is not known whether paired associative stimulation can strengthen neuronal connections persistently and have therapeutic effects that are clinically relevant. We recruited two patients with motor-incomplete chronic (one para- and one tetraplegic) spinal cord injuries. The patients received paired associative stimulation for 20-24 weeks. The paraplegic patient, previously paralyzed below the knee level, regained plantarflexion and dorsiflexion of the ankles of both legs. The tetraplegic patient regained grasping ability. The newly acquired voluntary movements could be performed by the patients in the absence of stimulation and for at least 1 month after the last stimulation session. In this unblinded proof-of-principle demonstration in two subjects, long-term paired associative stimulation induced persistent and clinically relevant strengthening of neural connections and restored voluntary movement in previously paralyzed muscles. Further study is needed to confirm whether long-term paired associative stimulation can be used in rehabilitation after spinal cord injury by itself and, possibly, in combination with other therapeutic strategies.

  2. Factors influencing bladder management in male patients with spinal cord injury: a qualitative study.

    Science.gov (United States)

    Engkasan, J P; Ng, C J; Low, W Y

    2014-02-01

    Qualitative study using individual in-depth interviews. The objective of this study was to explore the factors influencing the choice of bladder management for male patients with spinal cord injury (SCI). Public hospitals in Malaysia. Semistructured (one-on-one) interviews of 17 patients with SCI; 7 were in-patients with a recent injury and 10 lived in the community. All had a neurogenic bladder and were on various methods of bladder drainage. Interviews were audio-recorded, transcribed verbatim and analyzed using thematic analyses. The choice of bladder management was influenced by treatment attributes, patients' physical and psychological attributes, health practitioners' influences and social attributes. Participants were more likely to choose a treatment option that was perceived to be convenient to execute and helped maintain continence. The influence of potential treatment complications on decision making was more variable. Health professionals' and peers' opinions on treatment options had a significant influence on participants' decision. In addition, patients' choices depended on their physical ability to carry out the task, the level of family support received and the anticipated level of social activities. Psychological factors such as embarrassment with using urine bags, confidence in self-catheterization and satisfaction with the current method also influenced the choice of bladder management method. The choice of bladder management in people with SCI is influenced by a variety of factors and must be individualized. Health professionals should consider these factors when supporting patients in making decisions about their treatment options.

  3. Are the 10 meter and 6 minute walk tests redundant in patients with spinal cord injury?

    Directory of Open Access Journals (Sweden)

    Gail F Forrest

    Full Text Available OBJECTIVE: To evaluate the relationship and redundancy between gait speeds measured by the 10 Meter Walk Test (10MWT and 6 Minute Walk Test (6MWT after motor incomplete spinal cord injury (iSCI. To identify gait speed thresholds supporting functional ambulation as measured with the Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI. DESIGN: Prospective observational cohort. SETTING: Seven outpatient rehabilitation centers from the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN. PARTICIPANTS: 249 NRN patients with American Spinal Injury Association Impairment Scale (AIS level C (n = 20, D (n = 179 and (n = 50 iSCI not AIS evaluated, from February 2008 through April 2011. INTERVENTIONS: Locomotor training using body weight support and walking on a treadmill, overground and home/community practice. MAIN OUTCOME MEASURE(S: 10MWT and 6MWT collected at enrollment, approximately every 20 sessions, and upon discharge. RESULTS: The 10MWT and 6MWT speeds were highly correlated and the 10MWT speeds were generally faster. However, the predicted 6MWT gait speed from the 10MWT, revealed increasing error with increased gait speed. Regression lines remained significantly different from lines of agreement, when the group was divided into fast (≥0.44 m/s and slow walkers (<0.44 m/s. Significant differences between 6MWT and 10MWT gait speeds were observed across SCI-FAI walking mobility categories (Wilcoxon sign rank test p<.001, and mean speed thresholds for limited community ambulation differed for each measure. The smallest real difference for the 6MWT and 10MWT, as well as the minimally clinically important difference (MCID values, were also distinct for the two tests. CONCLUSIONS: While the speeds were correlated between the 6MWT and 10MWT, redundancy in the tests using predictive modeling was not observed. Different speed thresholds and separate MCIDs were defined for community ambulation for each test.

  4. The use of urologic investigations among patients with traumatic spinal cord injuries

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    Welk B

    2016-02-01

    Full Text Available Blayne Welk,1,2 Kuan Liu,2 Salimah Z Shariff,2 1Department of Surgery and Epidemiology and Biostatistics, Western University, ON, Canada; 2Institute for Clinical Evaluative Sciences – Western (ICES Western, London, ON, CanadaObjective: To assess the use of urologic investigations among traumatic spinal cord injury (TSCI patients.Methods: This is a retrospective cohort study from Ontario, Canada. We included all adult TSCI patients injured between 2002 and 2012. The primary outcome was the frequency of urodynamic testing, renal imaging, and cystoscopy. Primary exposure was the year of injury. The impact of age, sex, comorbidity, socioeconomic status, and lesion level was assessed with Cox regression models.Results: One thousand five hundred and fifty one incident TSCI patients were discharged from a rehabilitation hospital. The median follow-up time of this cohort was 5.0 years (interquartile range =2.9–7.5. At least one urodynamics, renal imaging, or cystoscopy was performed during follow-up for 50%, 80%, and 48% of the cohort, respectively. The overall rate of these tests was 0.22, 0.60, and 0.22 per person-year of follow-up. The proportion of patients who had regular, yearly urodynamics (<2%, renal imaging (6%, or cystoscopy (<2% was low. There were no significant linear trends in the use of these tests over the 10-year study period. Urodynamics were significantly less likely to be performed in patients over 65 years of age (hazard ratio [HR] =0.63, P<0.01 and those with a higher level of comorbidity (HR =0.72, P<0.01. Patients with quadriplegia were significantly less likely to receive any of the investigations compared to those with paraplegia.Conclusion: Renal imaging is done at least once for the majority of patients with TSCI; however, only half undergo urodynamics or cystoscopy. Few patients have regular urologic testing. The reality of urologic testing after TSCI is very different from urologist's ideals and practice guidelines

  5. Fractura and dislocation of the thoracic spine without spinal cord injury in a patient with ankylosing spondylitis: A case report.

    Science.gov (United States)

    Glinkowski, W

    2000-12-30

    This article presents a rare case of a fracture of the thoracic spine accompanied by significant dislocation but without spinal cord injury in a 74-year-old male patient with ankylosing spondylitis. A literature search failed to reveal a similar case. Conservative treatment produced a good outcome.

  6. Analysis of patients with spinal cord trauma associated with traumatic brain injury

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    João Simão de Melo Neto

    2014-12-01

    Full Text Available Objective: Characterize victims of spinal cord injury (SCI associated with traumatic brain injury (TBI and risk factors. Methods: Study conducted with 52 victims of SCI associated with TBI. The variables studied were: sex; age; marital status; occupation; educational level; religion; etiology and the lesion area; neurological condition by the ASIA scale; associated injuries and potential risk factors. Results: The male (85%, aged between 21-30 years (25%, civil status stable union (56%, low level of education (69% and the Roman Catholic religion (77% presented the greater number of victims. Motor vehicle accidents (58% were the main etiology. The cervical segment had higher injury risk (RR=3.48, p<0.0001. The neurological status ASIA-E (52%, the syndromic neck pain (35% and the rate of mild TBI (65% were the most frequent. Complications occurred in 13 patients with increased frequency of pneumonia (62%. The length of hospital stay was significantly higher (20±28 days and 17% of patients died. Men (RR=2.14, p=0.028 and individuals exposed to motor vehicle accidents (RR=1.91, p=0.022 showed a higher risk of these lesions concurrently. Moreover, these patients had 2.48 (p<0.01 higher risk of death than victims of SCI alone. Conclusion: The SCI associated with TBI was more frequent in men, young adults, and individuals exposed to motor vehicle accidents. The cervical spine is more likely to be affected. Furthermore, the length of hospitalization is significantly higher and the subjects analyzed have higher risk of death.

  7. Attitudes Towards Individuals with Spinal Cord Injuries

    Science.gov (United States)

    Conway, Cassandra Sligh D.; Gooden, Randy; Nowell, Jennifer; Wilson, Navodda

    2010-01-01

    This paper will shed light on the lives of persons with spinal cord injuries by revealing the literature on spinal cord injuries that focuses on research that can shed light on attitudes towards persons with spinal cord injuries. The background literature related to incidences, the definition of spinal cord injury, and vocational opportunities are…

  8. Factors determining social (interpersonal support in patients with vertebro-spinal cord injury

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    I. D. Boulyubash

    2016-01-01

    Full Text Available Objective: to study relationships between the specific features of the social network of patients with vertebro-spinal cord injury sequels (VSIS, subjectively perceived and actual social support, and social skills assessment by the patients.Patients and methods. In 2014–2015, a psychodiagnostic study was conducted in 41 VSIS patients (32 men and 9 women, including 18- to 20-year-olds (n=5, 21- to 30-year-olds (n=18, 31- to 40-year-olds (n=9, 41- to 50-year-olds (n=4, and patients over 50 years of age (n=5. Paraplegia (paraparesis and tetraplegia (tetraparesis were present in 30 and 11 patients, respectively. The duration of VSIS was 1 to 125 months. Correlations between different types of subjectively perceived and actual social support and the parameters of a social network of the patients were assessed.Results. Correlation analysis has showed that there is a need for psychotherapeutic interventions related to social network extension for patients so that the latter should have sufficient and persistent interpersonal support.

  9. International Spinal Cord Injury

    DEFF Research Database (Denmark)

    Dvorak, M F; Itshayek, E; Fehlings, M G

    2015-01-01

    the final version. RESULTS: The data set consists of nine variables: (1) Intervention/Procedure Date and start time (2) Non-surgical bed rest and external immobilization, (3) Spinal intervention-closed manipulation and/or reduction of spinal elements, (4) Surgical procedure-approach, (5) Date and time......STUDY DESIGN: Survey of expert opinion, feedback and final consensus. OBJECTIVE: To describe the development and the variables included in the International Spinal Cord Injury (SCI) Spinal Interventions and Surgical Procedures Basic Data set. SETTING: International working group. METHODS...... of the completion of the intervention or surgical closure; (6) Surgical procedure-open reduction, (7) Surgical procedure-direct decompression of neural elements, and (8 and 9) Surgical procedure-stabilization and fusion (spinal segment number and level). All variables are coded using numbers or characters. Each...

  10. [The Effectiveness of Abdominal Massage on Neurogenic Bowel Dysfunction in Patients With Spinal Cord Injury: A Systematic Review].

    Science.gov (United States)

    Wu, Tzu-Jung; Lin, Chiu-Chu; Wang, Hsiu-Hung

    2017-02-01

    Neurogenic bowel dysfunction is a common comorbidity in spinal cord injury patients that may result in fecal incontinence. Abdominal massage is one intestinal training method that is used to improve bowel movement and defecation. To review the effectiveness of abdominal massage on neurogenic bowel dysfunction in patients with spinal cord injury. A systematic review of Chinese and English-language articles was performed in six databases using the following key words: spinal cord injury, abdominal massage, neurogenic bowel dysfunction, and bowel training. Relevant studies published prior to June 2016 that met the inclusion and exclusion criteria were selected. The Downs and Black scale was used to appraise the quality of each of the included studies. Eight studies were included in the final analysis. Four of these studies indicated that abdominal massage significantly improved bowel functions and the regularity and frequency of bowel movements. Although two of the studies indicated that abdominal massage significantly reduced the use of glycerin and laxatives, the remaining six did not. The eight studies earned respective quality scores ranging between 13 and 25. The current literature lacks consensus on the efficacy of abdominal massage in terms of improving bowel dysfunction in patients with spinal cord injuries. Future studies should use more stringent experimental designs such as randomized controlled studies to explore the correlations among massage time and frequency and bowel function improvements in order to provide guidelines for clinical care applications.

  11. Social support and functioning in a patient with spinal cord injury: the role of social skills.

    Science.gov (United States)

    Müller, Rachel; Rauch, Alexandra; Cieza, Alarcos; Geyh, Szilvia

    2013-09-01

    This study reports on a patient with spinal cord injury (SCI) in whom the interaction between social skills and social support seems to influence functioning. The International Classification of Functioning, Disability and Health (ICF) was used as a reference framework. Qualitative (i.e. observation, structured, and open interviews with the patient and health professionals) and quantitative data (i.e. spinal cord independence measure, medical records) were collected. Content analysis of the interviews was carried out to identify aspects of social skills and social support. An ICF-based documentation tool (i.e. ICF Assessment Sheet) was used to structure information about the level of functioning of body functions and structures, activity and participation, and environmental and personal factors of a 57-year-old man with incomplete paraplegia during first rehabilitation. The patient presented a variety of effective social skills (i.e. assertiveness, goal direction). However, the adaptation of skills, such as asking for help social problem-solving, sensitivity, and expressivity in social relations, became necessary to acquire. The patient received different types of social support (i.e. emotional, informational, and instrumental) from different sources (e.g. family and friends). The qualitative interviews provided indications for an interaction between social skills and social support. The impact of social skills and social support on functioning is discussed. Social skills can mobilize social support and enhance functioning. However, better understanding of social skills, social support, and their interaction in relation to functioning in SCI is required to develop targeted and effective interventions to strengthen psychosocial resources for the enhancement of functioning in patients with SCI.

  12. Early Versus Late Tracheostomy for Patients with High and Low Cervical Spinal Cord Injuries

    Science.gov (United States)

    Guirgis, Akram H.; Menon, Venugopal K.; Suri, Neelam; Chatterjee, Nilay; Attallah, Emil; Saad, Maged Y.; Elshaer, Shereen

    2016-01-01

    Objectives This study aimed to evaluate the effects of early versus late tracheostomies among patients with cervical spinal cord injuries (CSCIs). Methods This retrospective study included 69 adult CSCI patients who underwent bedside percutaneous tracheostomies at the Intensive Care Unit of Khoula Hospital, Muscat, Oman, between January 2011 and October 2015. The tracheostomy was considered early if the procedure took place within one week of the CSCI. The impact of an early tracheostomy on patient outcomes was analysed in terms of duration of mechanical ventilation and intensive care unit (ICU) stay among patients with high (C1–C2 vertebrae) and low (C3–C7 vertebrae) CSCIs. Ventilator dependence, bradycardia episodes and surgical intervention outcomes were also examined. Results Patients with a high CSCI who underwent an early tracheostomy spent significantly fewer days on mechanical ventilation compared to those who underwent a late tracheostomy (9.3 ± 7.2 days versus 13.7 ± 3.2 days; P = 0.041). Low CSCI patients who received an early tracheostomy also experienced significantly fewer days on mechanical ventilation compared to those undergoing a late tracheostomy (12.1 ± 10.4 days versus 25.2 ± 17.7 days; P = 0.035). Moreover, ICU mortality was significantly lower for high CSCI patients who underwent an early tracheostomy (P = 0.015). However, there was no association between length of ICU stay and either type of CSCI or timing of the tracheostomy procedure. Conclusion An early tracheostomy is beneficial in reducing the duration of mechanical ventilation among patients with CSCIs, irrespective of the level of injury. PMID:28003892

  13. Early Versus Late Tracheostomy for Patients with High and Low Cervical Spinal Cord Injuries

    Directory of Open Access Journals (Sweden)

    Akram H. Guirgis

    2016-11-01

    Full Text Available Objectives: This study aimed to evaluate the effects of early versus late tracheostomies among patients with cervical spinal cord injuries (CSCIs. Methods: This retrospective study included 69 adult CSCI patients who underwent bedside percutaneous tracheostomies at the Intensive Care Unit of Khoula Hospital, Muscat, Oman, between January 2011 and October 2015. The tracheostomy was considered early if the procedure took place within one week of the CSCI. The impact of an early tracheostomy on patient outcomes was analysed in terms of duration of mechanical ventilation and intensive care unit (ICU stay among patients with high (C1–C2 vertebrae and low (C3–C7 vertebrae CSCIs. Ventilator dependence, bradycardia episodes and surgical intervention outcomes were also examined. Results: Patients with a high CSCI who underwent an early tracheostomy spent significantly fewer days on mechanical ventilation compared to those who underwent a late tracheostomy (9.3 ± 7.2 days versus 13.7 ± 3.2 days; P = 0.041. Low CSCI patients who received an early tracheostomy also experienced significantly fewer days on mechanical ventilation compared to those undergoing a late tracheostomy (12.1 ± 10.4 days versus 25.2 ± 17.7 days; P = 0.035. Moreover, ICU mortality was significantly lower for high CSCI patients who underwent an early tracheostomy (P = 0.015. However, there was no association between length of ICU stay and either type of CSCI or timing of the tracheostomy procedure. Conclusion: An early tracheostomy is beneficial in reducing the duration of mechanical ventilation among patients with CSCIs, irrespective of the level of injury.

  14. Improving self-efficacy in spinal cord injury patients through "design thinking" rehabilitation workshops.

    Science.gov (United States)

    Wolstenholme, Daniel; Downes, Tom; Leaver, Jackie; Partridge, Rebecca; Langley, Joseph

    2014-01-01

    Advances in surgical and medical management have significantly reduced the length of time that patients with spinal cord injury (SCI) have to stay in hospital, but has left patients with potentially less time to psychologically adjust. Following a pilot in 2012, this project was designed to test the effect of "design thinking" workshops on the self-efficacy of people undergoing rehabilitation following spinal injuries. Design thinking is about understanding the approaches and methods that designers use and then applying these to think creatively about problems and suggest ways to solve them. In this instance, design thinking is not about designing new products (although the approaches can be used to do this) but about developing a long term creative and explorative mind-set through skills such as lateral thinking, prototyping and verbal and visual communication. The principles of "design thinking" have underpinned design education and practice for many years, it is also recognised in business and innovation for example, but a literature review indicated that there was no evidence of it being used in rehabilitation or spinal injury settings. Twenty participants took part in the study; 13 (65%) were male and the average age was 37 years (range 16 to 72). Statistically significant improvements were seen for EQ-5D score (t = -3.13, p = 0.007) and Patient Activation Measure score (t = -3.85, p = 0.001). Other outcome measures improved but not statistically. There were no statistical effects on length of stay or readmission rates, but qualitative interviews indicated improved patient experience.

  15. Relationship of patient characteristics and rehabilitation services to outcomes following spinal cord injury: The SCIRehab Project

    Science.gov (United States)

    Whiteneck, Gale; Gassaway, Julie; Dijkers, Marcel P.; Heinemann, Allen W.; Kreider, Scott E. D.

    2012-01-01

    Background/objective To examine associations of patient characteristics along with treatment quantity delivered by seven clinical disciplines during inpatient spinal cord injury (SCI) rehabilitation with outcomes at rehabilitation discharge and 1-year post-injury. Methods Six inpatient SCI rehabilitation centers enrolled 1376 patients during the 5-year SCIRehab study. Clinicians delivering standard care documented details of treatment. Outcome data were derived from SCI Model Systems Form I and II and a project-specific interview conducted at approximately 1-year post-injury. Regression modeling was used to predict outcomes; models were cross-validated by examining relative shrinkage of the original model R2 using 75% of the dataset to the R2 for the same outcome using a validation subsample. Results Patient characteristics are strong predictors of outcome; treatment duration adds slightly more predictive power. More time in physical therapy was associated positively with motor Functional Independence Measure at discharge and the 1-year anniversary, CHART Physical Independence, Social Integration, and Mobility dimensions, and smaller likelihood of rehospitalization after discharge and reporting of pressure ulcer at the interview. More time in therapeutic recreation also had multiple similar positive associations. Time spent in other disciplines had fewer and mixed relationships. Seven models validated well, two validated moderately well, and four validated poorly. Conclusion Patient characteristics explain a large proportion of variation in multiple outcomes after inpatient rehabilitation. The total amount of treatment received during rehabilitation from each of seven disciplines explains little additional variance. Reasons for this and the phenomenon that sometimes more hours of service predict poorer outcome, need additional study. Note This is the first of nine articles in the SCIRehab series. PMID:23318033

  16. Levetiracetam in spinal cord injury pain: a randomized controlled trial

    DEFF Research Database (Denmark)

    Finnerup, N B; Grydehøj, J; Bing, J;

    2009-01-01

    . OBJECTIVES: The objective of the study was primarily to evaluate the efficacy of the anticonvulsant levetiracetam in patients with spinal cord injury (SCI) at- and below-level pain and secondarily to evaluate the effect on spasm severity. SETTING: Outpatients at two spinal cord units and a pain center...... severity following spinal cord injury....

  17. Immediate effect of transcutaneous electrical nerve stimulation on spasticity in patients with spinal cord injury.

    Science.gov (United States)

    Ping Ho Chung, Bryan; Kam Kwan Cheng, Benson

    2010-03-01

    To investigate the immediate effect of transcutaneous electrical nerve stimulation (TENS) on spasticity in patients with spinal cord injury. Randomized controlled trial. Extended rehabilitation centre. Eighteen subjects with spinal cord injury and symptoms of spasticity over lower limbs were randomly assigned to receive either 60 minutes of active TENS (0.25 ms, 100 Hz, 15 mA) or 60 minutes of placebo non-electrically stimulated TENS over the common peroneal nerve. Composite Spasticity Score was used to assess the spasticity level of ankle plantar flexors immediately before and after TENS application. Composite Spasticity Score consisted of Achilles tendon jerks, resistance to full-range passive ankle dorsiflexion and ankle clonus. Between-group statistical differences of reduction of Composite Spasticity Score, Achilles tendon jerks, resistance to full-range passive ankle dorsiflexion and ankle clonus were calculated using the Mann-Whitney test. Within-group statistical differences of Composite Spasticity Score, Achilles tendon jerks, resistance to full-range passive ankle dorsiflexion and ankle clonus were calculated using the Wilcoxon signed ranks test. Significant reductions were shown in Composite Spasticity Score by 29.5% (p = 0.017), resistance to full-range passive ankle dorsiflexion by 31.0% (p = 0.024) and ankle clonus by 29.6% (p = 0.023) in the TENS group but these reductions were not found in the placebo TENS group. The between-group differences of both Composite Spasticity Score and resistance to full-range passive ankle dorsiflexion were significant (p = 0.027 and p = 0.024, respectively). This study showed that a single session of TENS could immediately reduce spasticity.

  18. Cnages in activity limitations and predictors of functional outcome of patients with spinal cord injury following in patient rehabilitation

    Directory of Open Access Journals (Sweden)

    C. Joseph

    2013-01-01

    Full Text Available The purpose of this study was to investigate the changes in the activity limitations of patients following in-patient rehabilitation and the factors influencing functional ability as measured by the Spinal Cord independence measure III (SCIM III. A longitudinal study design was utilised to study the change in functional abilities of patients with spinal cord injury between admission and discharge. A convenient sampling strategy was employed, in which every consecutive patient admitted to the rehabilitation centre within a three-month period was eligible for the study. Demographic-, medical, and process of rehabilitation data were collected and collated from the patients’ medical records using a data gathering sheet that was validated and tested for reliability. functional abilities were measured by the SCIM III. Seventy-six patients met the inclusion criteria, consisting of 58 paraplegics and 18 tetraplegics. The mean age of this cohort was 34.14 years. A significant difference (p<0.001 in functional ability was detected for the total sample, with only 12.5% of patients independent in walking ability and 28.12% in stair management. four (4 factors were found to be predictors of functional outcomes on bivariate analysis, but when considered together in a multiple regression model, only functional status on admission remained correlated to functional outcomes. Conclusion and implication for practice: Significant improvement in functional abilities of persons with spinal cord injury following in-patient rehabilitation was observed. however, mobility and stair-management limitations were the most prevalent at discharge. lastly, a lower functional status should be better targeted to optimise functional ability in the future. future research should be directed towards illuminating whether personal factors or rehabilitation inefficiencies are responsible for the limitations observed at discharge.

  19. Biomarkers in spinal cord injury.

    NARCIS (Netherlands)

    Pouw, M.H.; Hosman, A.J.F.; Middendorp, J.J. van; Verbeek, M.M.; Vos, P.E.; Meent, H. van de

    2009-01-01

    STUDY DESIGN: Literature review. OBJECTIVES: In traumatic spinal cord injury (SCI), much effort has been put into the evaluation of SCI severity and the prediction of recovery potential. An accurate prediction of the initial damage of the spinal cord that differentiates between the severities of SCI

  20. Discrimination of Motor Imagery-Induced EEG Patterns in Patients with Complete Spinal Cord Injury

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    G. Pfurtscheller

    2009-01-01

    Full Text Available EEG-based discrimination between different motor imagery states has been subject of a number of studies in healthy subjects. We investigated the EEG of 15 patients with complete spinal cord injury during imagined right hand, left hand, and feet movements. In detail we studied pair-wise discrimination functions between the 3 types of motor imagery. The following classification accuracies (mean ± SD were obtained: left versus right hand 65.03% ± 8.52, left hand versus feet 68.19% ± 11.08, and right hand versus feet 65.05% ± 9.25. In 5 out of 8 paralegic patients, the discrimination accuracy was greater than 70% but in only 1 out of 7 tetraplagic patients. The present findings provide evidence that in the majority of paraplegic patients an EEG-based BCI could achieve satisfied results. In tetraplegic patients, however, it is expected that extensive training-sessions are necessary to achieve a good BCI performance at least in some subjects.

  1. Patients' perceptions of their roles in goal setting in a spinal cord injury regional rehabilitation program.

    Science.gov (United States)

    Draaistra, Harriett; Singh, Mina D; Ireland, Sandra; Harper, Theresa

    2012-01-01

    Goal setting is a common practice in rehabilitation, yet there is a paucity of literature exploring patients' perceptions of their roles in this process. This study was conducted using a qualitative descriptive methodology to explore patients' perceptions of their roles in setting goals in a spinal cord injury regional rehabilitation program. Imogene King's theory of goal attainment was used to frame the study. Data were collected through interviews and analyzed using a content analysis. The results revealed four themes: Visioning, Redefining, Brainstorming, and Rebuilding Participants (n = 13) envisioned their roles as setting an overarching priority goal, defining detailed rehabilitation goals, sharing knowledge with the team, and rebuilding skills to attain goals. Implications for nursing practice include the need to understand patients' experiences and perceptions, share knowledge, and support effective communication to promote collaborative goal setting. A need to enhance health professionals' education to fully understand factors influencing patients' abilities to set rehabilitation goals, and future research in methods to promote patients' engagement in goal setting was also clearly indicated.

  2. Epidemiological and clinical data of patients with spinal cord injury: Five-year experience of our center

    Directory of Open Access Journals (Sweden)

    Burhan Fatih Koçyiğit

    2015-06-01

    Full Text Available Objective: We aimed to present epidemiological and clinical data on spinal cord injury (SCI patients who were rehabilitated at our hospital to define etiological factors and high risk groups. Methods: Data on 174 SCI patients rehabilitated between January 2009 and October 2014 in our hospital were retrospectively evaluated. Patient age, sex, etiology of injury, injury level (cervical, thoracic, lumbar, total number of rehabilitation sessions, spinal operation status, functional groups according to the American Spinal Injury Association (ASIA Scale were recorded. Results: In total, 105 of the patients were male and 69 were female. The mean age of patients was 36.61 ± 16.16 years. Traffic accidents were the most common cause of injury (n=45, 25.9%, followed by falls from height (n=39, 22.4%. The most common injury was thoracic spine injury (n=95, 54.6%, followed by lumbar spine injuries (n=48, 27.6%. Traffic accidents were significant mechanism for thoracic spine injuries (p=0.007. Ineffective neurosurgery had a significant relation with lumbar spine injuries (p<0.001. Conclusion: The most of the SCIs we observed were preventable. Comprehensive identification of the epidemiologic, clinic and demographic features of SCIs contributes to define most common etiological factors, high risk groups, thereby making it possible to pay personal and communal attention to precautions for SCIs. J Clin Exp Invest 2015; 6 (2: 140-143

  3. Semiconditional electrical stimulation of pudendal nerve afferents stimulation to manage neurogenic detrusor overactivity in patients with spinal cord injury.

    Science.gov (United States)

    Lee, Young-Hee; Kim, Jung Moon; Im, Hyung Tae; Lee, Kye-Wook; Kim, Sung Hoon; Hur, Dong Min

    2011-10-01

    To evaluate the effect of semiconditional electrical stimulation of the pudendal nerve afferents for the neurogenic detrusor overactivity in patients with spinal cord injury. Forty patients (36 males, 4 males) with spinal cord injury who had urinary incontinence and frequency, as well as felt bladder contraction with bladder filling sense or autonomic dysreflexic symptom participated in this study. Patients with neurogenic detrusor overactivity were subdivided into complete injury and incomplete injury groups by ASIA classification and subdivided into tetraplegia and paraplegia groups by neurologic level of injury. Bladder function, such as bladder volumes infused to the bladder until the first occurrence of neurogenic detrusor overactivity (V(ini)) and the last contraction suppressed by electrical stimulation (V(max)) was measured by water cystometry (CMG) and compared with the results of each subgroup. Among the 40 subjects, 35 patients showed neurogenic detrusor overactivity in the CMG study. Among these 35 patients, detrusor overactivity was suppressed effectively by pudendal nerve afferent electrical stimulation in 32 patients. The infusion volume until the occurrence of the first reflex contraction (V(ini)) was 99.4±80.3 ml. The volume of saline infused to the bladder until the last contraction suppressed by semiconditional pudendal nerve stimulation (V(max)) was 274.3±93.2 ml, which was significantly greater than V(ini). In patients with good response to the pudendal nerve afferent stimulation, the bladder volume significantly increased by stimulation in all the patients. In this study, semiconditional electrical stimulation on the dorsal penile afferent nerve could effectively inhibit neurogenic detrusor overactivity and increase bladder volume in patients with spinal cord injury.

  4. What is the efficacy of physical therapeutics for treating neuropathic pain in spinal cord injury patients?

    Science.gov (United States)

    Fattal, C; Kong-A-Siou, D; Gilbert, C; Ventura, M; Albert, T

    2009-03-01

    Evaluate the place and level of proof of physical therapeutics for treating neuropathic pain in spinal cord injury (SCI) patients. Literature review from three databases: PubMed, Embase, Pascal. The following keywords were selected: chronic neuropathic pain/non-pharmacological treatment; transcutaneous electrical nerve stimulation, physiotherapy, acupuncture, physical therapy, transcranial magnetic stimulation, heat therapy, ice therapy, cold therapy, massage, ultrasound, alternative treatment, complementary treatment, occupational therapy. The articles were analyzed using the double-reading mode. Three techniques emerge from the literature: magnetic or electrical transcranial stimulation, transcutaneous electrical nerve stimulation and acupuncture. Even though the first method is not easily accessible on a daily basis it is the one that yields the most promising results validated by Grade B studies. Healthcare professionals remain faithful to pain-relieving transcutaneous neurostimulation for both segmental neuropathic pain and below-level central neuropathic pain. Acupuncture is advocated by Canadian teams and could offer some interesting options; however, to this day, it does not have the methodological support and framework required to validate its efficacy. All other physical therapies are used in a random way. Only below-level massages are advocated by the patients themselves. To this day, no study can validate the integration of physical therapy as part of the array of therapeutics used for treating neuropathic pain in SCI patients. In the future, it will require controlled and randomized therapeutic studies on homogenous groups of SCI patients, to control the various confusion factors.

  5. Spinal Cord Injury Rehabilitation in Nepal

    Directory of Open Access Journals (Sweden)

    Nabina Shah

    2013-06-01

    Full Text Available Spinal cord injury is a major trauma, with its short and long term effects and consequences to the patient, his friends and family. Spinal cord injury is addressed in the developed countries with standard trauma care system commencing immediately after injury and continuing to the specialized rehabilitation units. Rehabilitation is important to those with spinal injury for both functional and psychosocial reintegration. It has been an emerging concept in Nepal, which has been evident with the establishment of the various hospitals with rehabilitation units, rehabilitation centres and physical therapy units in different institutions. However, the spinal cord injury rehabilitation setting and scenario is different in Nepal from those in the developed countries since spinal cord injury rehabilitation care has not been adequately incorporated into the health care delivery system nor its importance has been realized within the medical community of Nepal. To name few, lack of human resource for the rehabilitation care, awareness among the medical personnel and general population, adequate scientific research evidence regarding situation of spinal injury and exorbitant health care policy are the important hurdles that has led to the current situation. Hence, it is our responsibility to address these apparent barriers to successful implementation and functioning of rehabilitation so that those with spinal injury would benefit from enhanced quality of life. Keywords: rehabilitation; spinal injury.

  6. Bladder management methods and urological complications in spinal cord injury patients

    Directory of Open Access Journals (Sweden)

    Roop Singh

    2011-01-01

    Full Text Available Background: The optimal bladder management method should preserve renal function and minimize the risk of urinary tract complications. The present study is conducted to assess the overall incidence of urinary tract infections (UTI and other urological complications in spinal cord injury patients (SCI, and to compare the incidence of these complications with different bladder management subgroups. Materials and Methods: 545 patients (386 males and 159 females of traumatic spinal cord injury with the mean age of 35.4±16.2 years (range, 18 - 73 years were included in the study. The data regarding demography, bladder type, method of bladder management, and urological complications, were recorded. Bladder management methods included indwelling catheterization in 224 cases, clean intermittent catheterization (CIC in 180 cases, condom drainage in 45 cases, suprapubic cystostomy in 24 cases, reflex voiding in 32 cases, and normal voiding in 40 cases. We assessed the incidence of UTI and bacteriuria as the number of episodes per hundred person-days, and other urological complications as percentages. Results: The overall incidence of bacteriuria was 1.70 / hundred person-days. The overall incidenceof urinary tract infection was 0.64 / hundered person-days. The incidence of UTI per 100 person-days was 2.68 for indwelling catheterization, 0.34 for CIC, 0.34 for condom drainage, 0.56 for suprapubic cystostomy, 0.34 for reflex voiding, and 0.32 for normal voiding. Other urological complications recorded were urethral stricture (n=66, 12.1%, urethritis (n=78, 14.3%, periurethral abscess (n=45, 8.2%, epididymorchitis (n=44, 8.07%, urethral false passage (n=22, 4.03%, urethral fistula (n=11, 2%, lithiasis (n=23, 4.2%, hematuria (n=44, 8.07%, stress incontinence (n=60, 11%, and pyelonephritis (n=6, 1.1%. Clean intermittent catheterization was associated with lower incidence of urological complications, in comparison to indwelling catheterization. Conclusions

  7. Spinal cord injury without radiographic abnormality

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    Singh Anil

    2006-01-01

    Full Text Available Spinal cord injury without radiological abnormality is rare in adults. Below we present a case report of 20 yrs old male with isolated cervical cord injury, without accompanying vertebral dislocation or fracture involving the spinal canal rim. He fell down on plain and smooth ground while carrying 40 kg weight overhead and developed quadriparesis with difficulty in respiration. Plain radiographs of the neck revealed no fractures or dislocations. MRI showed bulky spinal cord and an abnormal hyper intense signal on the T2W image from C2 vertebral body level to C3/4 intervertebral disc level predominantly in the anterior aspect of the cord The patient was managed conservatively with head halter traction and invasive ventilatory support for the initial 7 days period in the ICU. In our patient recovery was good and most of the neurological deficit improved over 4 weeks with conservative management.

  8. Effects of Functional Electrical Stimulation on Peak Torque and Body Composition in Patients with Incomplete Spinal Cord Injury

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    Chin-Wei Liu

    2007-05-01

    Full Text Available The aim of this study was to investigate the change in body composition, leg girths, and muscle strength of patients with incomplete spinal cord injury (SCI after functional electrical stimulation cycling exercises (FESCE. Eighteen subjects with incomplete SCI were recruited. Each patient received FESCE three times per week for 8 weeks. Body composition, thigh and calf girths of bilateral legs, muscle strength of bilateral knee flexors and extensors were measured before and after 4 and 8 weeks of FESCE. A significant increase in bilateral thigh girth after 4 weeks of FESCE and significant increase in muscular peak torque of knee flexion and extension were found after 8 weeks of training. Besides, lean body mass increased significantly after complete treatment. FESCE can increase the thigh girth and muscular peak torque of patients with incomplete spinal cord injury.

  9. Clinical algorithm for improved prediction of ambulation and patient stratification after incomplete spinal cord injury.

    Science.gov (United States)

    Zörner, Björn; Blanckenhorn, Wolf U; Dietz, Volker; Curt, Armin

    2010-01-01

    The extent of ambulatory recovery after motor incomplete spinal cord injury (miSCI) differs considerably amongst affected persons. This makes individual outcome prediction difficult and leads to increased within-group variation in clinical trials. The aims of this study on subjects with miSCI were: (1) to rank the strongest single predictors and predictor combinations of later walking capacity; (2) to develop a reliable algorithm for clinical prediction; and (3) to identify subgroups with only limited recovery of walking function. Correlation and logistic regression analyses were performed on a dataset of 90 subjects with tetra- or paraparesis, recruited in a prospective European multicenter study. Eleven measures obtained in the subacute injury period, including clinical examination, tibial somatosensory evoked potentials (tSSEP), and demographic factors, were related to ambulatory outcome (WISCI II, 6minWT) 6 months after injury. The lower extremity motor score (LEMS) alone and in combination was identified as most predictive for later walking capacity in miSCI. Ambulatory outcome of subjects with tetraparesis was correctly predicted for 92% (WISCI II) or 100% (6minWT) of the cases when LEMS was combined with either tSSEP or the ASIA Impairment Scale, respectively. For individuals with paraparesis, prediction was less distinct, mainly due to low prediction rates for individuals with poor walking outcome. A clinical algorithm was generated that allowed for the identification of a subgroup composed of individuals with tetraparesis and poor ambulatory recovery. These data provide evidence that a combination of predictors enables a reliable prediction of walking function and early patient stratification for clinical trials in miSCI.

  10. Intermittent catheterization in patients with traumatic spinal cord injury: obstacles, worries, level of satisfaction.

    Science.gov (United States)

    Yılmaz, B; Akkoç, Y; Alaca, R; Erhan, B; Gündüz, B; Yıldız, N; Gök, H; Köklü, K; Cınar, E; Alemdaroğlu, E; Ersöz, M; Karapolat, H; Demir, Y; Bardak, A N; Turna, I; Catalbaş, N; Güneş, S; Tunç, H

    2014-11-01

    The aim of this study is to examine the obstacles in people with traumatic spinal cord injury (SCI) face performing intermittent catheterization (IC), also their worries and level of satisfaction. Two hundred sixty-nine patients performing IC for at least 3 months were asked to fill-out a questionnaire about their opinions on IC. In total, 69.5% of patients performed IC themselves, 10.4% had performed by their mothers, 7.8% by another caregiver and 7.4% by their spouse. For the 72 (26%) patients unable to apply IC, reasons were insufficient hand function (56.1%), being unable to sit appropriately (35.4%) and spasticity (8.5%). In all, 70% of male patients had insufficient hand function, 20% could not sit and 10% had spasticity while 56.3% of female patients could not sit, 37.5% had insufficient hand function and 63% had spasticity. Difference between sexes was found to be statistically significant (Ppatients had when starting IC were fear of being dependent on IC (50.2%), accidentally injuring self (43.8%), embarrassment (43.2%), causing an infection (40.2%), bleeding (32.7%), fear of feeling pain (30.2%) and hygiene (24.7%). More women felt embarrassment; other items were similar in both sexes. In all, 46.9% of patients had urinary incontinence in intervals. In total, 69.5% of patients performed IC themselves. Men's most common obstacle was insufficient hand function while women's was being unable to sit appropriately. Patients' most common worries were being dependent on IC for life. In all, 46.9% had incontinence in intervals; 47.9% said IC improved their life quality; and 97.4% preferred IC over continuous catheterization.

  11. Percutaneous nerve stimulation in chronic neuropathic pain patients due to spinal cord injury: a pilot study.

    Science.gov (United States)

    Kopsky, David Jos; Ettema, Frank Willem Leo; van der Leeden, Marike; Dekker, Joost; Stolwijk-Swüste, Janneke Marjan

    2014-03-01

    The long-term prognosis for neuropathic pain resolution following spinal cord injury (SCI) is often poor. In many SCI patients, neuropathic pain continues or even worsens over time. Thus, new treatment approaches are needed. We conducted a pilot study to evaluate the feasibility and effect of percutaneous (electrical) nerve stimulation (P(E)NS) in SCI patients with chronic neuropathic pain. In 18 weeks, 12 P(E)NS treatments were scheduled. Assessment with questionnaires was performed at baseline (T0), after 8 weeks (T8), 18 weeks (T18), and 12 weeks post-treatment (T30). From 26 screened patients, 17 were included. In total, 91.2% questionnaires were returned, 2 patients dropped out, and 4.2% of the patients reported minor side effects. Pain scores on the week pain diary measured with the numerical rating scale improved significantly at T8, from 6.5 at baseline to 5.4, and were still significantly improved at T18. Pain reduction of ≥ 30% directly after a session was reported in 64.6% sessions. In total, 6 patients experienced reduction in size of the pain areas at T18 and T30, with a mean reduction of 45.8% at T18 and 45.3% at T30. P(E)NS is feasible as an intervention in SCI patients and might have a positive effect on pain reduction in a part of this patient group. © 2013 The Authors Pain Practice © 2013 World Institute of Pain.

  12. Right-sided infective endocarditis as a potentially fatal complication in patients with long-term refractory severe bradyarrhythmia after cervical spinal cord injury: A case report

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    Naoki Miura

    2015-08-01

    Full Text Available Bradyarrhythmia is usually a spontaneously subsiding complication of cervical spinal cord injury. However, in severe cases, it can lead to cardiac arrest. We report a case of cervical spinal cord injury, complicated by right-sided infective endocarditis after the placement of a temporary pacing catheter in the right ventricle for severe bradyarrhythmia that led to cardiac arrest. Although the patient׳s condition was successfully treated by pacing catheter removal and pharmacological therapy, right-sided infective endocarditis would be a fatal complication in cases of cervical spinal cord injury where cardiac pacing is required for long-term refractory severe bradyarrhythmia.

  13. Magnetic resonance imaging of cervical cord injury and its correlation with the patient's outcome

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    Panggabean, F.; Nakamura, Tsutomu (Kanazawa Medical Univ., Uchinada, Ishikawa (Japan))

    1991-03-01

    Thirty four patients with cervical cord injuries were studied by magnetic resonance imaging (MRI) with reference to neurological deficits. Studies in the acute or subacute stage were made in 25 patients, of whom 17 patients were studied consecutively up to the chronic stage. Chronic studies were made in 26 patients. In acute or subacute MRI studies 12 patients had an intramedullary high signal intensity (HSI) in the traumatized area on T2-weighted image (T2-WI). In consecutive studies HSI appeared persistently up to the chronic stage in four patients, and a low signal intensity (LSI) appeared a few months after the injury at T1-WI, to this point disclosing the area of iso-signal intensity. The HSI in the remaining eight patients disappeared at least in three months. The former MRI findings might suggest the development of myelomalacia from acute hemorrhagic necrosis while the latter might be edema of the traumatized spinal cord. Nine patients of chronic MRI studies showed myelomalacia in six, syringomyelia in two, and transection of the spinal cord in one patient respectively. Significant correlations between MRI findings and neurological deficits in acute and chronic stage were present. It was concluded that those who had no intramedullary abnormality in MRI showed less severe neurological deficits and better outcomes, while those who had intramedullary abnormality in MRI showed severe neurological deficits and poor outcomes. (author).

  14. Assessment of sexual functions after spinal cord injury in Indian patients.

    Science.gov (United States)

    Sharma, Sansar C; Singh, Roop; Dogra, Rajeev; Gupta, Shyam S

    2006-03-01

    This study assessed the interacting physical, psychological and social aspects of sexuality among 86 males and 14 females with spinal cord injury (SCI). Data collection involved the use of a 42-item study-specific questionnaire designed to determine different aspects of sexuality. Subjects were rated, after interview, on a scale according to an integrated index of sexual function (IISF). It was observed that patients scoring higher on this index were sexually more active and showed positive sexual adjustments. A higher incidence of complications of SCI, partner dissatisfaction, less partner co-operation, lower self-esteem and social taboos were factors responsible for less sexual activity in our patients. The present study suggests that there is a strong need for improved treatment of the medical complications of SCI, sexual counselling, literature, information and peer support in this country. We are of the opinion that the IISF can be utilized in rehabilitation settings to examine the interplay of the various complex factors in sexual rehabilitation post-SCI.

  15. Psychological Aspects of Spinal Cord Injury

    Science.gov (United States)

    Cook, Daniel W.

    1976-01-01

    Reviewing literature on the psychological impact of spinal cord injury suggests: (a) depression may not be a precondition for injury adjustment; (b) many persons sustaining cord injury may have experienced psychological disruption prior to injury; and (c) indexes of rehabilitation success need to be developed for the spinal cord injured. (Author)

  16. Evaluation of spinal cord injury animal models

    Institute of Scientific and Technical Information of China (English)

    Ning Zhang; Marong Fang; Haohao Chen; Fangming Gou; Mingxing Ding

    2014-01-01

    Because there is no curative treatment for spinal cord injury, establishing an ideal animal model is important to identify injury mechanisms and develop therapies for individuals suffering from spinal cord injuries. In this article, we systematically review and analyze various kinds of animal models of spinal cord injury and assess their advantages and disadvantages for further studies.

  17. Effects of transcutaneous electrical nerve stimulation on pain in patients with spinal cord injury: a randomized controlled trial.

    Science.gov (United States)

    Bi, Xia; Lv, Hong; Chen, Bin-Lin; Li, Xin; Wang, Xue-Qiang

    2015-01-01

    [Purpose] To investigate the effects of transcutaneous electrical nerve stimulation (TENS) on pain in patients with spinal cord injury. [Subjects and Methods] Fifty-two spinal cord injury patients with central pain were randomly allocated into two groups TENS and control with 26 subjects per group. The patients in TENS and control groups were treated with TENS and sham TENS for 20 min (three times a week) for 12 consecutive weeks, respectively. The two group's pain was assessed using visual analog scale (VAS) and the McGill Pain Questionnaire (including pain rating index-total, pain rating index-affective, pain rating index-sensory, present pain intensity, and number of words chosen) before and after the treatment. [Results] After the intervention, we found significant differences in VAS, pain rating index-total, pain rating index-affective, pain rating index-sensory, present pain intensity, and number of words chosen between the TENS group and the control group. [Conclusion] Our results suggest that TENS effectively decreases pain in patients with spinal cord injury.

  18. Overview of ethical issues for conducting neuroprotective clinical trials in patients with spinal cord injury

    OpenAIRE

    Saberi H; Derakhshanrad N; Ghajarzadeh M

    2015-01-01

    Hooshang Saberi,1,2 Nazi Derakhshanrad,1 Mahsa Ghajarzadeh1 1Brain and Spinal Cord Injury Research Center, Imam Khomeini Hospital, 2Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran Abstract: Animals have been used in medical and biological researches worldwide for long time. Almost all of these studies are published with the hope of clinical application. However, there are meticulous criteria considering results of animal studies in clin...

  19. Virtual reality in rehabilitation: WIITM as an occupational therapy tool in patients with spinal cord injuries

    OpenAIRE

    Fundación del Lesionado Medular

    2014-01-01

    The use of virtual reality has gained importance in the rehabilitation sector over the last few years. The Wii™ console complements traditional treatment by exercising the motor skills in a motivating context, which is important in long-term interventions, such as spinal cord injury. Objectives: to describe our work with the Wii™ console and the different support products used in occupational therapy at the Fundación del Lesionado Medular, and to discuss advantages and disadvantages. ...

  20. Vibration-induced finger flexion reflex and inhibitory effect of acupuncture on this reflex in cervical spinal cord injury patients.

    Science.gov (United States)

    Takakura, N; Iijima, S; Kanamaru, A; Shibuya, M; Homma, I; Ohashi, M

    1996-12-01

    The vibration-induced finger flexion reflex (VFR) and the inhibitory effect of acupuncture on this reflex were studied in five cervical spinal cord injury patients (C-SCIs). VFR, which is a tonic finger flexion reflex induced by vibratory stimulation on the finger tip, was induced before and after acupuncture was carried out on the same hand. A stainless steel needle was inserted to the Hoku point. As in healthy subjects, VFR was performed and it was significantly inhibited by acupuncture in the C-SCIs; mean maximum VFR was 204.2 +/- S.E. 68.6 g before and 119.8 +/- S.E. 42.2 g after acupuncture. The present results suggest that at least part of the reflex center for VFR is located in the spinal cord and that part of VFR inhibition by acupuncture may be mediated via the spinal cord.

  1. Transcranial magnetic stimulation after spinal cord injury.

    Science.gov (United States)

    Awad, Basem I; Carmody, Margaret A; Zhang, Xiaoming; Lin, Vernon W; Steinmetz, Michael P

    2015-02-01

    To review the basic principles and techniques of transcranial magnetic stimulation (TMS) and provide information and evidence regarding its applications in spinal cord injury clinical rehabilitation. A review of the available current and historical literature regarding TMS was conducted, and a discussion of its potential use in spinal cord injury rehabilitation is presented. TMS provides reliable information about the functional integrity and conduction properties of the corticospinal tracts and motor control in the diagnostic and prognostic assessment of various neurological disorders. It allows one to follow the evolution of motor control and to evaluate the effects of different therapeutic procedures. Motor-evoked potentials can be useful in follow-up evaluation of motor function during treatment and rehabilitation, specifically in patients with spinal cord injury and stroke. Although studies regarding somatomotor functional recovery after spinal cord injury have shown promise, more trials are required to provide strong and substantial evidence. TMS is a promising noninvasive tool for the treatment of spasticity, neuropathic pain, and somatomotor deficit after spinal cord injury. Further investigation is needed to demonstrate whether different protocols and applications of stimulation, as well as alternative cortical sites of stimulation, may induce more pronounced and beneficial clinical effects. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Spinal Cord Injury Model System Information Network

    Science.gov (United States)

    ... Go New to Website Managing Bowel Function After Spinal Cord Injury Resilience, Depression and Bouncing Back after SCI Getting ... the UAB-SCIMS Contact the UAB-SCIMS UAB Spinal Cord Injury Model System Newly Injured Health Daily Living Consumer ...

  3. Robotic treadmill training improves cardiovascular function in spinal cord injury patients.

    Science.gov (United States)

    Turiel, Maurizio; Sitia, Simona; Cicala, Silvana; Magagnin, Valentina; Bo, Ivano; Porta, Alberto; Caiani, Enrico; Ricci, Cristian; Licari, Vittorio; De Gennaro Colonna, Vito; Tomasoni, Livio

    2011-06-16

    Body weight supported treadmill training (BWSTT) assisted with a robotic driven gait orthosis (DGO) is an emerging tool in rehabilitating patients with lost sensorimotor function. Few information about the effects of BWSTT on cardiovascular system are available. The purpose of this study was to determine the effects of BWSTT on: 1) left ventricular (LV) systo-diastolic function; 2) coronary flow reserve (CFR); 3) endothelial function in patients with lost sensorimotor function due to neurologic lesions. Fourteen adults (males 10, age 50.6±17.1years) with motor incomplete spinal cord injuries (SCI) due to trauma or spondylotic diseases underwent standard echocardiographic examination, non invasive assessment of CFR by dipyridamole stress echo and determination of plasma asymmetric dimethylarginine (ADMA) levels at baseline and after 6weeks of BWSTT. At post training evaluation we observed lower LV end-diastolic (P=0.0164) and end-systolic volumes (P=0.0029) with increased ejection fraction (EF) (P=0.0266). We also observed a LV interventricular septum (IVS) (P=0.00469) increase. At the same time, we detected an improvement of LV diastolic function as witnessed by the reduction of isovolumic relaxation time (IVRT) (P=0.0404) and deceleration time (DT) (P=0.0405) with an increased E/A ratio (P=0.0040). Improved CFR (P=0.020) and reduced plasma ADMA levels (P=0.0005) have been observed too, in association with a reduction of the inflammatory status (C-reactive protein (CRP) (P=0.0022) and erythrocyte sedimentation rate (ESR) (P=0.0005)). For the first time, this study demonstrated that 6weeks of BWSTT improved not only the sensorimotor function but also systo-diastolic LV function, CFR and endothelial dysfunction associated with a reduction of the inflammatory status in patients with incomplete SCI. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  4. Improved Gait Speed After Robot-Assisted Gait Training in Patients With Motor Incomplete Spinal Cord Injury: A Preliminary Study

    Science.gov (United States)

    2017-01-01

    Objective To evaluate the clinical features that could serve as predictive factors for improvement in gait speed after robotic treatment. Methods A total of 29 patients with motor incomplete spinal cord injury received 4-week robot-assisted gait training (RAGT) on the Lokomat (Hocoma AG, Volketswil, Switzerland) for 30 minutes, once a day, 5 times a week, for a total of 20 sessions. All subjects were evaluated for general characteristics, the 10-Meter Walk Test (10MWT), the Lower Extremity Motor Score (LEMS), the Functional Ambulatory Category (FAC), the Walking Index for Spinal Cord Injury version II (WISCI-II), the Berg Balance Scale (BBS), and the Spinal Cord Independence Measure version III (SCIM-III) every 0, and 4 weeks. After all the interventions, subjects were stratified using the 10MWT score at 4 weeks into improved group and non-improved group for statistical analysis. Results The improved group had younger age and shorter disease duration than the non-improved group. All subjects with the American Spinal Injury Association Impairment Scale level C (AIS-C) tetraplegia belonged to the non-improved group, while most subjects with AIS-C paraplegia, AIS-D tetraplegia, and AIS-D paraplegia belonged to the improved group. The improved group showed greater baseline lower extremity strength, balance, and daily living function than the non-improved group. Conclusion Assessment of SCIM-III, BBS, and trunk control, in addition to LEMS, have potential for predicting the effects of robotic treatment in patients with motor incomplete spinal cord injury. PMID:28289633

  5. Early methylprednisolone impact treatment for sensory and motor function recovery in patients with acute spinal cord injury A self-control study

    Institute of Scientific and Technical Information of China (English)

    Chao Zhuang; Liming Wang; Yan Xu

    2008-01-01

    BACKGROUND: For the treatment of spinal cord injury, any pathological changes of the injured tissue should be primarily corrected or reversed. Any remaining fibrous function and neurons with intact structure should be retained, and the toxic substances caused by ischemia-hypoxia following spinal cord injury, should be eliminated to create a favorable environment that would promote neural functional recovery. OBJECTIVE: This study was designed to investigate the effects of the impact of early methylprednisolone-treatment on the sensory and motor function recovery in patients with acute spinal cord injury. DESIGN: A self-control observation. SETTING: Department of Spine Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China. PARTICIPANTS: Forty-three patients with acute spinal cord injury were admitted to the Department of Spine Surgery, First Affiliated Hospital of Nanjing Medical University, between October 2005 and September 2007. These patients were recruited for the present study. The patients comprised 33 males and 10 females, and all met with the inclusive criteria namely, the time between suffering from acute spinal cord injury and receiving treatment was less than or equal to eight hours. METHODS: According to the protocol determined by the State Second Conference of Acute Spinal Cord Injury of USA, all patients received the drop-wise administration of a 30-mg/kg dose of methylprednisolone (H200040339,500mg/bottle, Pharmacia N.V/S.A, Belgium) for 15 minutes within 8 hours post injury. After a 45-minute interval, methylprednisolone was administered at 5.4mg/kg/h for 23 hours. MAIN OUTCOME MEASURES: Prior to and post treatment, acupuncture sense and light touch scoring were performed at 28 dermatomic area key points, including occipital tuberosity and supraclavicular fossa. At the same time, motor scoring of key muscles among 10 pairs of sarcomeres was also performed.RESULTS: All 43 patients participated in the final

  6. Hyperbaric oxygen therapy of spinal cord injury

    Directory of Open Access Journals (Sweden)

    Nitesh P Patel

    2017-01-01

    Full Text Available Spinal cord injury (SCI is a complex disease process that involves both primary and secondary mechanisms of injury and can leave patients with devastating functional impairment as well as psychological debilitation. While no curative treatment is available for spinal cord injury, current therapeutic approaches focus on reducing the secondary injury that follows SCI. Hyperbaric oxygen (HBO therapy has shown promising neuroprotective effects in several experimental studies, but the limited number of clinical reports have shown mixed findings. This review will provide an overview of the potential mechanisms by which HBO therapy may exert neuroprotection, provide a summary of the clinical application of HBO therapy in patients with SCI, and discuss avenues for future studies.

  7. Amikacin Dosing and Monitoring in Spinal Cord Injury Patients: Variation in Clinical Practice Between Spinal Injury Units and Differences in Experts' Recommendations

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    Subramanian Vaidyanathan

    2006-01-01

    Full Text Available The objective of this article was to determine the current practice on amikacin dosing and monitoring in spinal cord injury patients from spinal cord physicians and experts. Physicians from spinal units and clinical pharmacologists were asked to provide protocol for dosing and monitoring of amikacin therapy in spinal cord injury patients. In a spinal unit in Poland, amikacin is administered usually 0.5 g twice daily. A once-daily regimen of amikacin is never used and amikacin concentrations are not determined. In Belgium, Southport (U.K., Spain, and the VA McGuire Medical Center (Richmond, Virginia, amikacin is given once daily. Whereas peak and trough concentrations are determined in Belgium, only trough concentration is measured in Southport. In both these spinal units, modification of the dose is not routinely done with a nomogram. In Spain and the VA McGuire Medical Center, monitoring of serum amikacin concentration is not done unless a patient has renal impairment. In contrast, the dose/interval of amikacin is adjusted according to pharmacokinetic parameters at the Edward Hines VA Hospital (Hines, Illinois, where amikacin is administered q24h or q48h, depending on creatinine clearance. Spinal cord physicians from Denmark, Germany, and the Kessler Institute for Rehabilitation (West Orange, New Jersey state that they do not use amikacin in spinal injury patients. An expert from Canada does not recommend determining serum concentrations of amikacin, but emphasizes the value of monitoring ototoxicity and nephrotoxicity. Experts from New Zealand recommend amikacin in conventional twice- or thrice-daily dosing because of the theoretical increased risk of neuromuscular blockade and apnea with larger daily doses in spinal cord injury patients. On the contrary, experts from Greece, Israel, and the U.S. recommend once-daily dosing and determining amikacin pharmacokinetic parameters for each patient. As there is considerable variation in clinical

  8. Health-related Quality of Life in caregivers of patients with spinal cord injury (SCI. A Greek review

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    Aikaterini Kotroni

    2012-01-01

    Full Text Available Background: Health – related quality of life and spinal cord injuries are two parameters that are becoming a key concept in research due to medical and rehabilitative care advances resulting in extended life expectancies for those with SCI. People with SCI often have significant functional limitations and lack of independence according to their level of injury. In such cases, help from others is needed, and this is often provided by a family member. The responsibility of caregiving can lead to physical injury and emotional distress not only for the caregiver but also the person with SCI.Aim: The objective of this study was to review the data associated with the Health-related Quality of Life in SCI patients and their family caregivers.Methodology: A literature review of national and international studies was performed in databases of PubMed and Scopus using keywords such as spinal cord injury, caregivers, quality of life, physical activity, subjective well-being, health promotion, depression.Results: Several studies indicate the positive impact of health promotion/wellness interventions and of social support services that could be provided for both patients and their caregivers.Conclusions: Caregiving has been studied extensively among those providing services to elderly or cognitively impaired people. On the contrary, there has been relatively little focus on caregiving in SCI patients. Further research is needed to address strategies that could effectively optimize, support and increase not only caregiver’sbut also patient’s quality of life.

  9. Determining prognosis after spinal cord injury.

    Science.gov (United States)

    Vazquez, Xoan Miguens; Rodriguez, Maria Sol; Peñaranda, Jose Manuel Suarez; Concheiro, Luis; Barus, Jose Ignacio Muñoz

    2008-01-01

    Disability following traumatic spine injury often requires assessment for judicial reasons. To determine the optimum time to carry out a medico-legal evaluation. Retrospective study (1995-2000) of patients with traumatic spine injury with a follow-up of five years. The American Spinal Injury Association (ASIA) scale was used to determine level and extent of the injury. Statistical analysis by SPSS 11.0. 173 injuries were analyzed (39.3% ASIA A; 15.6% ASIA B; 29.47% ASIA C; 15.6% ASIA D). Neurological improvement was detected in 35.83%, more frequently in incomplete injuries. ASIA A injuries remained mainly complete from admission to discharge and in no case reached functional levels. Only a third of ASIA B patients showed improvement, of whom 33.3% were functional. Improvement in ASIA C patients was 76.4%, these and all ASIA D patients were functional on discharge. The condition a year after the injury remained unchanged in all cases, regardless of the extent of injury. Patients who showed improvement did so early on, mainly during hospitalization. The optimum time for evaluation of spinal cord injury for medicolegal purposes is at one year after the injury. In cases of complete injury, evaluation can be carried out on discharge with no need to wait for one year.

  10. Effect of baclofen combined with neural facilitation technique on the reduction of muscular spasm in patients with spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: Recent researches have demonstrated that baclofen is a commonly central anti-spasm drug. In addition, neural facilitation technique based on nerve development and neurophysiology is widely used for rehabilitation training of motor disorder after central nerve injury. However, whether baclofen combining with neural facilitation technique can relieve muscular spasm after spinal cord injury needs further studies.OBJECTIVE: To observe the effect of baclofen combining with neural facilitation technique on decreasing muscular tension in two lower extremities after spinal cord injury.DESIGN: Randomized controlled study.SETTING: Departments of Rehabilitation and Orthopaedics, the Third Affiliated Hospital of Guangzhou Medical College.PARTICIPANTS: A total of 28 patients with spinal cord injury, including 17 males and 11 females, whose age ranged from 31 to 71 years, were selected from Departments of Rehabilitation and Orthopaedics, the Third Affiliated Hospital of Guangzhou Medical College from March 2005 to September 2006. The illness course ranged from 22 to 54 days and the mean course was (38 ± 8) days. All patients were diagnosed as the first onset and the increase of extensor muscular tension in two lower extremities after thoracic vertebra injury by using spine MR or CT examination. Informed consents were obtained from all the patients.METHODS: All 28 patients who had upper motor neuronal paralysis in two lower extremities after spinal cord injury in thoracic vertebra region were randomly divided into treatment group and control group with 14 cases in each group. Patients in both groups received routine therapy, while those in the treatment group were treated with oral baclofen (the beginning dosage: 5 mg/time; three times per day, 5 mg was increased every three days; the maximal dosage was 60 mg/day; 6 weeks in total) (made in Weicai Pharmaceutical Co., Ltd.;tablet; batch number: HC20040029) combining with neural facilitation technique, which accorded

  11. Spinal cord injury at birth

    DEFF Research Database (Denmark)

    Fenger-Gron, Jesper; Kock, Kirsten; Nielsen, Rasmus G

    2008-01-01

    UNLABELLED: A case of perinatally acquired spinal cord injury (SCI) is presented. The foetus was vigorous until birth, the breech presented and delivery was performed by a non-traumatic Caesarean section. The infant displayed symptoms of severe SCI but diagnosis was delayed due to severe co...

  12. The effects of transcranial direct current stimulation in patients with neuropathic pain from spinal cord injury.

    Science.gov (United States)

    Ngernyam, Niran; Jensen, Mark P; Arayawichanon, Preeda; Auvichayapat, Narong; Tiamkao, Somsak; Janjarasjitt, Suparerk; Punjaruk, Wiyada; Amatachaya, Anuwat; Aree-uea, Benchaporn; Auvichayapat, Paradee

    2015-02-01

    Transcranial direct current stimulation (tDCS) has demonstrated efficacy for reducing neuropathic pain, but the respective mechanisms remain largely unknown. The current study tested the hypothesis that pain reduction with tDCS is associated with an increase in the peak frequency spectrum density in the theta-alpha range. Twenty patients with spinal cord injury and bilateral neuropathic pain received single sessions of both sham and anodal tDCS (2 mA) over the left primary motor area (M1) for 20 min. Treatment order was randomly assigned. Pre- to post-procedure changes in pain intensity and peak frequency of electroencephalogram spectral analysis were compared between treatment conditions. The active treatment condition (anodal tDCS over M1) but not sham treatment resulted in significant decreases in pain intensity. In addition, consistent with the study hypothesis, peak theta-alpha frequency (PTAF) assessed from an electrode placed over the site of stimulation increased more from pre- to post-session among participants in the active tDCS condition, relative to those in the sham tDCS condition. Moreover, we found a significant association between a decrease in pain intensity and an increase in PTAF at the stimulation site. The findings are consistent with the possibility that anodal tDCS over the left M1 may be effective, at least in part, because it results in an increase in M1 cortical excitability, perhaps due to a pain inhibitory effect of motor cortex stimulation that may influence the descending pain modulation system. Future research is needed to determine if there is a causal association between increased left anterior activity and pain reduction. The results provide new findings regarding the effects of tDCS on neuropathic pain and brain oscillation changes. Copyright © 2014 International Federation of Clinical Neurophysiology. All rights reserved.

  13. Patients with Chronic Spinal Cord Injury Exhibit Reduced Autonomic Modulation during an Emotion Recognition Task

    Science.gov (United States)

    Varas-Díaz, Gonzalo; Brunetti, Enzo P.; Rivera-Lillo, Gonzalo; Maldonado, Pedro E.

    2017-01-01

    Spinal cord injury (SCI) is a devastating event for individuals, who frequently develop motor and sensory impairment as well as autonomic dysfunction. Previous studies reported that autonomic activity plays a major role in social cognition and that difficulties in the ability to interpret social information are commonly observed in a variety of mental disorders, which in turn correlate with a poor autonomic nervous system (ANS) regulation. It is well established that subjects with SCI have an alteration in ANS regulation mechanisms. We hypothesized that subjects diagnosed with SCI, who are experiencing a period of adaptation and socio-labor insertion suffer alterations in an emotion recognition task, a component of social cognition, which correlate with poor ANS regulation. We evaluated ANS function by measuring the heart rate variability (HRV) in 18 healthy subjects and 10 subjects with SCI. A 5-min baseline HRV was compared to a task period while performing The reading the mind in the eyes test (RMET). We found that while both groups have similar general performance in the test, healthy subjects responded with greater certainty during the RMET. This level of certainty during the RMET was positively correlated with baseline HRV measures in this group. Also, the group of healthy subjects exhibited higher HRV at baseline than participants with SCI. Finally, the changes in HRV between baseline and task condition were significantly higher in healthy individuals than in SCI participants. Our results show that patients with SCI have low levels of autonomic regulation mechanisms which may promote social cognition problems during their reinsertion to daily life. PMID:28228721

  14. Serotonin syndrome caused by minimum doses of SSRIS in a patient with spinal cord injury

    OpenAIRE

    Satoh, Koichiro; Takano, Shizuko; Onogi, Takashi; Ohtsuki, Koji; Kobayashi, Toshio

    2006-01-01

    There have been only a few reports of serotonin syndrome developing after mono-therapy with a selective serotonin reuptake inhibitor (SSRI). We report a case of serotonin syndrome caused by long-term therapy with fluvoxamine prior to treatment with paroxetine. An 18-year-old man with spinal cord injury (SCI) at thoracic level 2-3 presented with onset of serotonin syndrome after taking fluvoxamine (50 mg per day) for 8 weeks prior to treatment with paroxetine (10 mg per day) for 6 days. He had...

  15. Pharmacological management of hemodynamic complications following spinal cord injury.

    Science.gov (United States)

    McMahon, Deanna; Tutt, Matthew; Cook, Aaron M

    2009-05-01

    Damage from spinal cord injury (SCI) may be complicated by concomitant hemodynamic alterations within hours to months of the initial insult. Neurogenic shock, symptomatic bradycardia, autonomic dysreflexia, and orthostatic hypotension are specific conditions occurring commonly with SCI. Early recognition and appropriate management of each disorder may minimize secondary injury to the cord, avert systemic complications, and help alleviate patient discomfort.

  16. A web-based neurological pain classifier tool utilizing Bayesian decision theory for pain classification in spinal cord injury patients

    Science.gov (United States)

    Verma, Sneha K.; Chun, Sophia; Liu, Brent J.

    2014-03-01

    Pain is a common complication after spinal cord injury with prevalence estimates ranging 77% to 81%, which highly affects a patient's lifestyle and well-being. In the current clinical setting paper-based forms are used to classify pain correctly, however, the accuracy of diagnoses and optimal management of pain largely depend on the expert reviewer, which in many cases is not possible because of very few experts in this field. The need for a clinical decision support system that can be used by expert and non-expert clinicians has been cited in literature, but such a system has not been developed. We have designed and developed a stand-alone tool for correctly classifying pain type in spinal cord injury (SCI) patients, using Bayesian decision theory. Various machine learning simulation methods are used to verify the algorithm using a pilot study data set, which consists of 48 patients data set. The data set consists of the paper-based forms, collected at Long Beach VA clinic with pain classification done by expert in the field. Using the WEKA as the machine learning tool we have tested on the 48 patient dataset that the hypothesis that attributes collected on the forms and the pain location marked by patients have very significant impact on the pain type classification. This tool will be integrated with an imaging informatics system to support a clinical study that will test the effectiveness of using Proton Beam radiotherapy for treating spinal cord injury (SCI) related neuropathic pain as an alternative to invasive surgical lesioning.

  17. Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: The SCIRehab project

    Science.gov (United States)

    Teeter, Laura; Gassaway, Julie; Taylor, Sally; LaBarbera, Jacqueline; McDowell, Shari; Backus, Deborah; Zanca, Jeanne M.; Natale, Audrey; Cabrera, Jordan; Smout, Randall J.; Kreider, Scott E. D.; Whiteneck, Gale

    2012-01-01

    Background/objective Examine associations of type and quantity of physical therapy (PT) interventions delivered during inpatient spinal cord injury (SCI) rehabilitation and patient characteristics with outcomes at the time of discharge and at 1 year post-injury. Methods Physical therapists delivering routine care documented details of PT interventions provided. Regression modeling was used to predict outcomes at discharge and 1 year post-injury for a 75% subset; models were validated with the remaining 25%. Injury subgroups also were examined: motor complete low tetraplegia, motor complete paraplegia, and American Spinal Injury Association (ASIA) Impairment Scale (AIS) D motor incomplete tetra-/paraplegia. Results PT treatment variables explain more variation in three functionally homogeneous subgroups than in the total sample. Among patients with motor complete low tetraplegia, higher scores for the transfer component of the discharge motor Functional Independence Measure () are strongly associated with more time spent working on manual wheelchair skills. Being male is the most predictive variable for the motor FIM score at discharge for patients with motor complete paraplegia. Admission ASIA lower extremity motor score (LEMS) and change in LEMS were the factors most predictive for having the primary locomotion mode of “walk” or “both (walk and wheelchair)” on the discharge motor FIM for patients with AIS D injuries. Conclusion Injury classification influences type and quantity of PT interventions during inpatient SCI rehabilitation and is a strong predictor of outcomes at discharge and 1 year post-injury. The impact of PT treatment increases when patient groupings become more homogeneous and outcomes become specific to the groupings. Note This is the second of nine articles in the SCIRehab series. PMID:23318034

  18. Respiratory management of pediatric patients with spinal cord injuries: retrospective review of the duPont experience.

    Science.gov (United States)

    Padman, Raj; Alexander, Michael; Thorogood, Christine; Porth, Susan

    2003-03-01

    Pulmonary complications contribute to morbidity and mortality in spinal cord injuries (SCIs). A retrospective review of 20 years of experience with tracheostomy- and ventilator-dependent SCI children is presented. The authors developed and analyzed a database of 47 children (average age = 11.4 years). Of the patients, 27% had concomitant brain injuries, 6% had prior histories of reactive airway disease, and 2% had thoracic fractures. Injuries were caused by motor vehicle accidents (53%); gunshot wounds (19%); sports-related accidents (19%); and vascular injuries, transverse myelitis, or spinal tumors (8%). Of the injuries, 52% were high level (C1 to C2) and 48% were mid- or low level (C3 to C5). Two groups were analyzed for demographic information. Complications included tracheitis, atelectasis, and pneumonia. Mean tidal volume was 14 cm2/kg (maximum = 22 cm2/kg). Bedside lung function parameters were attempted to assess readiness and the rapidity of weans. T-piece sprints were used to successfully wean 63% of patients. Successfully weaned patients were compared with those not weaned. No deaths or readmissions for late-onset respiratory failure postwean occurred. The authors' clinical impression favors higher tidal volumes and aggressive bronchial hygiene to minimize pulmonary complications and enhance weaning. Successfully weaned patients had fewer complications. A critical pathway for respiratory management of SCI children is presented.

  19. Spinal Cord Injury

    Science.gov (United States)

    ... injury. Limited mobility may lead to a more sedentary lifestyle, placing you at risk of obesity, cardiovascular disease ... belt or use an age- and weight-appropriate child safety seat. To protect them from air bag ...

  20. Epidemiologic evidence of spinal cord injury in Tamil Nadu, India

    Directory of Open Access Journals (Sweden)

    Neelamegan Sridharan

    2015-01-01

    Full Text Available Background: Spinal cord injury is a fearsome disability leading to increased rate of morbidity and mortality. Information about the incidence of spinal cord injury may provide support for the healthcare advancements. The aim of the present study is to investigate the epidemiology of spinal cord injury. Methods: The present study was carried out in Rajiv Gandhi government general hospital, Chennai, India. The study design was approved by the institutional human ethical committee. Questionnaire was used to collect the information from the patients in a prospective manner. The American Spinal Injury Association (ASIA scoring systems was used to evaluate the severity of spinal cord injury. Results: A total of 245 cases of spinal injury were studied. Among them, 88 % (n=216 were male and 12% (n=29 were female. Spinal cord injuries of falls from height were prominent over the road traffic accident. Cervical level injuries are widespread in males and dorsal level Injuries are common in females. Conclusion: Hence awareness of the spinal cord injury and availability of healthcare facilities may minimise the consequences of spinal cord injury. [Int J Res Med Sci 2015; 3(1.000: 220-223

  1. The Effectiveness and Safety of Exoskeletons as Assistive and Rehabilitation Devices in the Treatment of Neurologic Gait Disorders in Patients with Spinal Cord Injury: A Systematic Review.

    Science.gov (United States)

    Fisahn, Christian; Aach, Mirko; Jansen, Oliver; Moisi, Marc; Mayadev, Angeli; Pagarigan, Krystle T; Dettori, Joseph R; Schildhauer, Thomas A

    2016-12-01

    Study Design Systematic review. Clinical Questions (1) When used as an assistive device, do wearable exoskeletons improve lower extremity function or gait compared with knee-ankle-foot orthoses (KAFOs) in patients with complete or incomplete spinal cord injury? (2) When used as a rehabilitation device, do wearable exoskeletons improve lower extremity function or gait compared with other rehabilitation strategies in patients with complete or incomplete spinal cord injury? (3) When used as an assistive or rehabilitation device, are wearable exoskeletons safe compared with KAFO for assistance or other rehabilitation strategies for rehabilitation in patients with complete or incomplete spinal cord injury? Methods PubMed, Cochrane, and Embase databases and reference lists of key articles were searched from database inception to May 2, 2016, to identify studies evaluating the effectiveness of wearable exoskeletons used as assistive or rehabilitative devices in patients with incomplete or complete spinal cord injury. Results No comparison studies were found evaluating exoskeletons as an assistive device. Nine comparison studies (11 publications) evaluated the use of exoskeletons as a rehabilitative device. The 10-meter walk test velocity and Spinal Cord Independence Measure scores showed no difference in change from baseline among patients undergoing exoskeleton training compared with various comparator therapies. The remaining primary outcome measures of 6-minute walk test distance and Walking Index for Spinal Cord Injury I and II and Functional Independence Measure-Locomotor scores showed mixed results, with some studies indicating no difference in change from baseline between exoskeleton training and comparator therapies, some indicating benefit of exoskeleton over comparator therapies, and some indicating benefit of comparator therapies over exoskeleton. Conclusion There is no data to compare locomotion assistance with exoskeleton versus conventional KAFOs

  2. Control of demyelination for recovery of spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    WU Bo; REN Xian-jun

    2008-01-01

    Since loss of of oligodendrocytes and consequent demyelination of spared axons severely impair the functional recovery of injured spinal cord,it is reasonably expected that the reduction of oligodendroglial death and enhanced remyelination of demyelinated axons will have a therapeutic potential to treat spinal cord injury.Amelioration of axonal myelination in the injured spinal cord is valuable for recovery of the neural function of incompletely injured patients.Here,this article presents an overview about the pathophysiology and mechanism of axonal demyelination in spinal cord injury and discusses its therapeutic significance in the treatment of spinal cord injury.Moreover,it further introduces the recent strategies to improve the axonal myeliantion to facilitate functional recovery of spinal cord injury.

  3. Physical therapy resources in prevention of bone mineral density loss in patients with spinal cord injury – literature review

    Directory of Open Access Journals (Sweden)

    Daniele Rodrigues

    2004-03-01

    Full Text Available This paper comprises a literature review on physical therapytreatment on prevention, stabilization or slowing down the processof bone mineral density loss in patients with spinal cord injury.There are few studies in the literature on the efficiency of physicaltherapy treatment for bone demineralization. There are reports offour types of treatment for demineralization: functional electricalstimulation, functional electrical stimulation-induced cycling,standing and ambulation. These treatments are rather questionableand controversial in relation to efficacy and there is no consensuson their methodologies.

  4. Evaluation of varicocele frequency of patients with spinal cord injury by color Doppler ultrasonography: A new etiological factor for varicocele?

    Energy Technology Data Exchange (ETDEWEB)

    Unsal, Alparslan [Adnan Menderes University, Faculty of Medicine, Department of Radiology, 09100 Aydin (Turkey)]. E-mail: aunsal@adu.edu.tr; Yilmaz, Bilge [Turkish Armed Forces Rehabilitation and Care Center, Department of Physical Medicine and Rehabilitation, Bilkent, Ankara (Turkey); Turgut, Ahmet Tuncay [Ankara Training and Research Hospital, Department of Radiology, Ankara (Turkey); Taskin, Fuesun [Adnan Menderes University, Faculty of Medicine, Department of Radiology, 09100 Aydin (Turkey); Alaca, Ridvan [Turkish Armed Forces Rehabilitation and Care Center, Department of Physical Medicine and Rehabilitation, Bilkent, Ankara (Turkey); Karaman, Can Zafer [Adnan Menderes University, Faculty of Medicine, Department of Radiology, 09100 Aydin (Turkey)

    2006-01-15

    Purpose: To evaluate the varicocele frequency of patients with spinal cord injury by color Doppler ultrasonography. Materials and methods: Sixty patients {l_brace}48 patients with upper motor neuron injury (U-MNI) and 12 patients with lower-MNI{r_brace} with traumatic spinal cord injury and age matched 48 healthy volunteers were enrolled in this prospective study. Testis volumes and varicocele grades were determined. Presence of varicocele was also classified according to clinical significance. Results: Testis volumes of U-MNI sub-group (14.81 {+-} 4.74 ml) were significantly smaller than the control group (18.20 {+-} 4.52 ml, p = 0.000) and L-MNI sub-group (17.88 {+-} 3.23 ml, p = 0.008). No left-sided clinical varicocele was found in L-MNI sub-group (0/12, 0%), whereas there were 14 patients in control group (14/48, 29%) and 7 patients in U-MNI sub-group (7/47, 15%), and the difference was statistically significant (p = 0.000, 0.007, respectively). Conclusion: Clinical varicocele frequency of U-MNI patients, who have spastic paralysis of abdominal and lower extremity muscles, is similar to the control group. This finding inspires that increased intra-abdominal pressure via normal to increased abdominal muscle tonus may have a role in the varicocele etiology, beside the classical factors. Absence of clinical varicocele in L-MNI patients, who have flaccid paralysis of the same muscle groups, supports this observation.

  5. Haemodynamic collapse in a patient with acute inferior myocardial infarction and concomitant traumatic acute spinal cord injury.

    Science.gov (United States)

    Kumagai, Naoto; Dohi, Kaoru; Tanigawa, Takashi; Ito, Masaaki

    2013-11-22

    A 71-year-old man suddenly collapsed and went into cardiopulmonary arrest. The cardiopulmonary resuscitation attempt succeeded in restoration of spontaneous circulation. The initial 12-lead electrocardiogram showed inferior acute myocardial infarction (AMI). The patient was initially diagnosed as having cardiogenic shock associated with inferior AMI. In spite of early coronary revascularisation, bradycardia and hypotension were sustained. After termination of sedation and extubation, he was found to have a quadriplegia and diagnosed with a cervical spinal cord injury (SCI). Therefore, the patient was finally diagnosed with neurogenic shock caused by acute cervical SCI due to the traumatic injury preceded by loss of consciousness complicating inferior AMI. We should recognise that SCI has unique haemodynamic features that mimic those associated with inferior AMI, but requires very different treatment.

  6. Hydraulic spinal cord and cauda equina nerve injuries

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@Hydraulic spinal cord and cauda equina nerve injuries are very uncommon. Since 19 96, we have received and treated 4 patients with hydraulic spinal cord and cauda equina injuries. This report gives a detail description. Four patients with hydraulic spinal cord and cauda equina nerve injuries, male: 3, female: 1, aging 13-56 years have been treated in our hospital since 1996. E xtradural blocking injury was in 1 patient, extradural anaesthesia injury in 1 p atient and intraspinal canal myelography injury in 2 patients; the segments of i ntraspinal canal were L2-3 and L3-4. One patient was accompanied b y femoral fracture, 2 patients by intraspinal tumor and 1 patient had operat ion because of prolapse of lumbar intervertebral disc.

  7. Vitamin B(12) deficiency as a cause of delirium in a patient with spinal cord injury.

    Science.gov (United States)

    Harrington, Amanda L; Dixon, Thomas M; Ho, Chester H

    2011-11-01

    A man with spinal cord injury (SCI) and multiple medical comorbidities had new-onset delirium during his 14th month of hospitalization. Diagnostic workup did not elicit an obvious etiology for mental status changes. Delirium persisted despite psychiatry intervention, and he was unable to be weaned from the ventilator because of prolonged agitation. Routine anemia workup revealed a possible untreated vitamin B(12) deficiency, although laboratory values were inconclusive. Empiric treatment with cyanocobalamin injections was initiated, and his delirium remarkably resolved after 3 weeks of treatment. We provide a concise review of the etiologies and varied clinical presentations of vitamin B(12) deficiency. As illustrated in this case, classic laboratory findings may not appear, and neurologic impairments from SCI can obscure the physical signs of deficiency, making diagnosis difficult. Empiric treatment may be indicated in cases of neuropsychiatric abnormalities not explained by other causes. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  8. The Prediction of Mobility Gains in Cervical Spinal Cord Injuries

    Science.gov (United States)

    1976-01-01

    U.S. DEPARTMENT OF COMMERCE National Technical Information Service AD-A027 771 THE PREDICTION OF MOBILITY GAINS IN CERVICAL SPINAL CORD INJURIES ...The treatment of spinal cord injuries is a controversial subject among physicians 8,10 The choice of a particular procedure depends ~on the...location and severity of the injury as well as ffhe physical condition of the patient. The effectiveness of the treatment is usually rrasured in terms of

  9. Spinal cord injury reveals multilineage differentiation of ependymal cells.

    OpenAIRE

    Konstantinos Meletis; Fanie Barnabé-Heider; Marie Carlén; Emma Evergren; Nikolay Tomilin; Oleg Shupliakov; Jonas Frisén

    2008-01-01

    Author Summary Spinal cord injuries occur in more than 30.000 individuals each year worldwide and result in significant morbidity, with patients requiring long physical and medical care. The recent identification of resident stem cells in the adult spinal cord has opened up for the possibility of pharmacological manipulation of these cells to produce cell types promoting recovery after injury. We have employed genetic tools to specifically address the identity and reaction to injury of a spin...

  10. Early elective colostomy following spinal cord injury.

    Science.gov (United States)

    Boucher, Michelle

    Elective colostomy is an accepted method of bowel management for patients who have had a spinal cord injury (SCI). Approximately 2.4% of patients with SCI have a colostomy, and traditionally it is performed as a last resort several years after injury, and only if bowel complications persist when all other methods have failed. This is despite evidence that patients find a colostomy easier to manage and frequently report wishing it had been performed earlier. It was noticed in the author's spinal unit that increasing numbers of patients were requesting colostomy formation during inpatient rehabilitation following SCI. No supporting literature was found for this; it appears to be an emerging and untested practice. This article explores colostomy formation as a method of bowel management in patients with SCI, considers the optimal time for colostomy formation after injury and examines issues for health professionals.

  11. Infarct of the Right Basal Ganglia in a Male Spinal Cord Injury Patient: Adverse Effect of Autonomic Dysreflexia

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    Subramanian Vaidyanathan

    2011-01-01

    Full Text Available Autonomic dysreflexia is a clinical emergency that occurs in individuals with spinal cord injury at level T-6 and above. We present a 58-year-old male patient with paraplegia who developed a severe, recurrent, throbbing headache during the night, which was relieved by emptying the urinary bladder by intermittent catheterisation. As this person continued to get episodes of severe headache for more than 6 months, computed tomography (CT of the brain was performed. CT revealed an infarct measuring 1.2 cm in the right basal ganglia. In order to control involuntary detrusor contractions, the patient was prescribed propiverine hydrochloride 15 mg four times a day. The alpha-adrenoceptor blocking drug doxazosin was used to reduce the severity of autonomic dysreflexia. Following 4 weeks of treatment with propiverine and doxazosin, the headache subsided completely. We learned from this case that bladder spasms in individuals with spinal cord injury can lead to severe, recurrent episodes of autonomic dysreflexia that, in turn, can predispose to vascular complications in the brain. Therefore, it is important to take appropriate steps to control bladder spasms and thereby prevent recurrent episodes of autonomic dysreflexia. Intermittent catheterisations along with an alpha-adrenoceptor blocking drug (doxazosin and an antimuscarinic drug (propiverine hydrochloride helped this individual to control autonomic dysreflexia, triggered by bladder spasms during the night.

  12. Challenges in Diagnosis and Treatment of a Cervical Spinal Cord Injury Patient with Melanoma, Adenocarcinoma, and Hepatic and Osteolytic Metastases: Need to Implement Strategies for Prevention and Early Detection of Cancer in Spinal Cord Injury Patients

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2012-01-01

    Full Text Available A male tetraplegic patient with, who had been taking warfarin, developed haematuria. Ultrasound scan revealed no masses, stones, or hydronephrosis. Urinary bladder had normal configuration with no evidence of masses or organised haematoma. Urine cytology revealed no malignant cells. Four months later, CT urography revealed an irregular mass at the base of urinary bladder. Cystoscopic biopsy revealed moderately differentiated adenocarcinoma, which contained goblet cells and pools of mucin showing strongly positive immunostaining for prostatic acid hosphatase and patchy staining for prostate specific antigen. Computed Tomography revealed multiple hypodense hepatic lesions and several osteolytic areas in femoral heads and iliac bone. With a presumptive diagnosis of prostatic carcinoma, leuprorelin acetate 3.75 mg was prescribed. This patient expired a month later. Conclusion. (i Spinal cord injury patient, who passed blood in urine while taking warfarin, requires repeated investigations to look for urinary tract neoplasm. (ii Anti-androgen therapy should be prescribed for 2 weeks prior to administration of gonadorelin analogue to prevent tumour flare causing bone pain, bladder outlet obstruction, uraemia, and cardiovascular risk due to hypercoagulability associated with a rapid increase in tumour burden. (iii Spinal cord physicians should adopt a caring and compassionate approach while managing tetraplegic patients with several co-morbidities, as aggressive diagnostic tests and therapeutic procedures may lead to deterioration in the quality of life.

  13. Challenges in Diagnosis and Treatment of a Cervical Spinal Cord Injury Patient with Melanoma, Adenocarcinoma, and Hepatic and Osteolytic Metastases: Need to Implement Strategies for Prevention and Early Detection of Cancer in Spinal Cord Injury Patients

    Science.gov (United States)

    Vaidyanathan, Subramanian; Mansour, Paul; Hughes, Peter L.; Selmi, Fahed; Singh, Gurpreet; Pulya, Kamesh; Soni, Bakul M.

    2012-01-01

    A male tetraplegic patient with, who had been taking warfarin, developed haematuria. Ultrasound scan revealed no masses, stones, or hydronephrosis. Urinary bladder had normal configuration with no evidence of masses or organised haematoma. Urine cytology revealed no malignant cells. Four months later, CT urography revealed an irregular mass at the base of urinary bladder. Cystoscopic biopsy revealed moderately differentiated adenocarcinoma, which contained goblet cells and pools of mucin showing strongly positive immunostaining for prostatic acid hosphatase and patchy staining for prostate specific antigen. Computed Tomography revealed multiple hypodense hepatic lesions and several osteolytic areas in femoral heads and iliac bone. With a presumptive diagnosis of prostatic carcinoma, leuprorelin acetate 3.75 mg was prescribed. This patient expired a month later. Conclusion. (i) Spinal cord injury patient, who passed blood in urine while taking warfarin, requires repeated investigations to look for urinary tract neoplasm. (ii) Anti-androgen therapy should be prescribed for 2 weeks prior to administration of gonadorelin analogue to prevent tumour flare causing bone pain, bladder outlet obstruction, uraemia, and cardiovascular risk due to hypercoagulability associated with a rapid increase in tumour burden. (iii) Spinal cord physicians should adopt a caring and compassionate approach while managing tetraplegic patients with several co-morbidities, as aggressive diagnostic tests and therapeutic procedures may lead to deterioration in the quality of life. PMID:23227385

  14. Hope, social support and self-esteem of patients with spinal cord injuries.

    Science.gov (United States)

    Piazza, D; Holcombe, J; Foote, A; Paul, P; Love, S; Daffin, P

    1991-08-01

    A descriptive study was conducted to determine if a relationship among the variables of hope, social support and self-esteem existed in persons with spinal cord injuries. A demographic data sheet and three instruments were used: Miller Hope Scale (MHS), Personal Resource Questionnaire Part II (PRQ) and Rosenberg Self-Esteem Scale (RSES). Of the 83 inpatients and outpatients who agreed to participate, 77 sets of questionnaires were usable. Ages of subjects ranged from 18-73 (mean 34.8) years and levels of injury ranged from C4-L3. The mean scores on the tools were: MHS-153.51 (40-200 possible range), PRQ-137.42 (25-175 possible range) and RSES-29.59 (10-40 possible range). There was a statistically significant relationship between hope and social support, hope and self-esteem and social support and self-esteem. By multiple regression analysis, the best predictors of hope in the subjects were self-esteem, social support and education.

  15. Neurological outcome in surgically treated patients with incomplete closed traumatic cervical spinal cord injury.

    Science.gov (United States)

    Singhal, B; Mohammed, A; Samuel, J; Mues, J; Kluger, P

    2008-09-01

    Retrospective study based on a reference paper. Neurological outcome in patients who were managed surgically with closed traumatic cervical spine injury was evaluated using the ASIA motor scoring system and Frankel grading. To assess the accuracy of motor charting and Frankel grading as tools to evaluate neurological outcome in closed traumatic cervical spine injury, and also to evaluate how the surgically treated patients fared in their neurological recovery by measurement tools as in the reference paper. National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK. Fifty-seven patients were admitted within 2 days of the injury with closed traumatic cervical spine injuries (1997-2004). Thirty-seven (65%) met the inclusion criteria as per the referenced paper, that is, were treated surgically, were Frankel grade B and above and had at least 12 months follow up. The remaining 20 patients were not included as they did not meet the inclusion criteria. The breakdown of the 20 patients is given in Table 1. The mean recovery percentage (MRP) and mean deficit percentage (MDP) were calculated as per the referenced paper. An evaluation of 37 patients surgically treated, who had follow up of at least 12 months, showed that preservation of pin prick below the level of lesion, and preservation of anal tone and perianal sensation were good prognostic indicators. There was no correlation between degree of encroachment of canal or the degree of kyphosis to MDP or MRP. The mean time from injury to mobilization was 7.6 days in 25 out of 37 patients. Twelve of the 37 patients had prolonged immobilization because of ITU stay or because they were initially treated conservatively. Three out of the 37 patients developed DVT/PE. Mean hospital stay was 6.4 months. The neurological outcome in surgically treated patients is comparable to the conservatively treated patients. The Frankel grading and ASIA motor charting combined is a powerful tool in assessing the neurological

  16. Training professionals' communication and motivation skills to improve spinal cord injury patients' satisfaction and clinical outcomes: Study protocol of the ESPELMA trial.

    Science.gov (United States)

    Lusilla-Palacios, Pilar; Castellano-Tejedor, Carmina; Lucrecia-Ramírez-Garcerán; Navarro-Sanchís, José A; Rodríguez-Urrutia, Amanda; Parramon-Puig, Gemma; Valero-Ventura, Sergi; Cuxart-Fina, Ampar

    2015-10-01

    Acute spinal cord injury leaves patients severely impaired and generates high levels of psychological distress among them and their families, which can cause a less active role in rehabilitation, worse functional recovery, and less perceived satisfaction with the results. Additionally, rehabilitation professionals who deal with this psychological distress could ultimately experience higher stress and more risk of burnout. This article presents the study protocol of the ESPELMA project, aimed to train rehabilitation professionals in the clinical management of acute spinal cord injury-associated psychological distress, and to measure the impact of this training on the patients' perceived satisfaction with treatment.

  17. [Proposal for a survey for assisting the family and caregivers of patients with spinal cord injuries].

    Science.gov (United States)

    Mancussi e Faro, A C

    1999-12-01

    This study proposes a basis survey for assistance to the family and caregivers because we believe there is necessity of family participation on the treatment, trying to understand and share the disease or deficiency situation. We objectified to sketch the relationship degree and the people's gender that accompanied the spinal cord injured hurt medular patient in nursing consultations and to discuss the necessity of basis survey to the assistance family and to the caregiver. 101 nursing consultations were accomplished, in clinic health, to the spinal cord injured patient and his/her relative and 36 patients were totalized, from this number 26 (72.22%) were male and 10 (27.78%), were female. It was verified that the men with medular lesion, in the greater number (27-80.7 O/o), were accompanied with his relatives specially mother and wife, while the women with medular lesion, in the greater number too (7-70%) were accompanied with her relatives of diversified proximity. In reference to the basis survey that comprehend the care at house and the caregiver necessity, we can affirm its relevance, trying to context the family support identified attending the caregivers.

  18. Should Complete and Incomplete Spinal Cord Injury Patients Receive the Same Attention in Urodynamic Evaluations and Ultrasonography Examinations of the Upper Urinary Tract?

    Science.gov (United States)

    Akkoc, Yesim; Cinar, Yasemin; Kismali, Erkan

    2012-01-01

    The aim of the study was to compare urodynamic findings and upper urinary tract (UUT) abnormalities detected by ultrasonography in complete and incomplete suprasacral spinal cord injury (SCI) patients with neurogenic detrusor overactivity. Thirty-eight suprasacral SCI patients who underwent ultrasonography evaluation of the UUT and urodynamic…

  19. Should Complete and Incomplete Spinal Cord Injury Patients Receive the Same Attention in Urodynamic Evaluations and Ultrasonography Examinations of the Upper Urinary Tract?

    Science.gov (United States)

    Akkoc, Yesim; Cinar, Yasemin; Kismali, Erkan

    2012-01-01

    The aim of the study was to compare urodynamic findings and upper urinary tract (UUT) abnormalities detected by ultrasonography in complete and incomplete suprasacral spinal cord injury (SCI) patients with neurogenic detrusor overactivity. Thirty-eight suprasacral SCI patients who underwent ultrasonography evaluation of the UUT and urodynamic…

  20. Magnetic resonance imaging of spinal cord injury in chronic stage

    Energy Technology Data Exchange (ETDEWEB)

    Tobimatsu, Haruki; Nihei, Ryuichi; Kimura, Tetsuhiko; Yano, Hideo; Touyama, Tetsuo; Tobimatsu, Yoshiko; Suyama, Naoto; Yoshino, Yasumasa (National Rehabilitation Center for the Disabled, Tokorozawa, Saitama (Japan))

    1991-10-01

    Magnetic resonance (MR) images of a total of 195 patients with cervical (125) or thoracic (70) spinal cord injury were reviewed. The imaging studies of the spinal cord lesions were correlated with clinical manifestations. Sequential MR imaging revealed hypointensity on T1-weighted images (T1WI) and hyperintensity on T2-weighted images (T2WI) in all patients, except for five patients showing no signal changes and two showing isointensity, suggesting gliosis, myelomalacia, and syringomyelia. Spinal cord lesions were classified into four types: small lesions, large lesions, complete transverse, and longitudinal rupture. These lesions were well correlated with the severity of injury and paralysis. Complete paralysis was frequently associated with enlarged, complete transverse for cervical spinal cord injury, and longitudinal ruptured or thinned complete transverse for thoracic spinal cord injury. The height of paralysis was well in agreement with that of lesions. For incomplete paralysis, localized lesions were seen within the spinal cord, coinciding with the paralysis or severity. Traumatic syringomyelia was seen in 17 patients (8.7%)-- for the cervical site (10 patients, 8%) and the thoracic site (7 patients, 10%). When homogeneous and marginally clear hypointensity is shown on T1-weighted images and vacuolated hyperintensity is shown on T2-weighted images, in addition to lesions spreading two or more cords or 1.5 or more cords above the nervous root level of paralysis, traumatic syringomyelia is strongly suspected, requiring the follow up observation. (N.K.).

  1. Open Access Platforms in Spinal Cord Injury.

    Science.gov (United States)

    Kramer, John L K; Geisler, Fred; Ramer, Leanne; Plunet, Ward; Cragg, Jacquelyn J

    2017-01-01

    Recovery from acute spinal cord injury (SCI) is characterized by extensive heterogeneity, resulting in uncertain prognosis. Reliable prediction of recovery in the acute phase benefits patients and their families directly, as well as improves the likelihood of detecting efficacy in clinical trials. This issue of heterogeneity is not unique to SCI. In fields such as traumatic brain injury, Parkinson's disease, and amyotrophic lateral sclerosis, one approach to understand variability in recovery has been to make clinical trial data widely available to the greater research community. We contend that the SCI community should adopt a similar approach in providing open access clinical trial data.

  2. Characteristics of neuropathic pain and its relationship with quality of life in 72 patients with spinal cord injury.

    Science.gov (United States)

    Nagoshi, N; Kaneko, S; Fujiyoshi, K; Takemitsu, M; Yagi, M; Iizuka, S; Miyake, A; Hasegawa, A; Machida, M; Konomi, T; Machida, M; Asazuma, T; Nakamura, M

    2016-09-01

    A cross-sectional study. Neuropathic pain (NP) after spinal cord injury (SCI) tends to be hard to treat, and its heterogeneous properties make it difficult to identify and characterize. This study was conducted to assess the characteristics of SCI-related NP in detail. A single hospital for SCI rehabilitation. This study included 72 patients who were seen at our hospital in 2012 and 2013 and who had sustained SCI at least 3 months before enrollment. The patients completed the Neuropathic Pain Symptom Inventory (NPSI) and the Short Form (SF)-36 Health Inventory. The NPSI score was analyzed for correlations with clinical presentations of SCI and SF-36 subitems. Paresthesia/dysesthesia was the most common subtype of NP after SCI. With regard to location, below-level superficial NP was significantly more intense than at-level pain. Patients who underwent surgery showed significantly less evoked pain compared with patients with non-surgery. Patients reported significantly more severe pain if >1 year had elapsed after the SCI. Patients with an American Spinal Injury Association Impairment Scale grade of B for completeness of injury reported more intense NP than those with other grades. Among the SF-36 subitems, NP correlated significantly with bodily pain, general health and mental health. NP in SCI patients was significantly associated with the location of pain, the time period since the injury, surgery and quality-of-life factors. A more detailed understanding of the characteristics of NP may contribute to better strategies for relieving the pain associated with SCI.

  3. Segmental hypersensitivity and spinothalamic function in spinal cord injury pain

    DEFF Research Database (Denmark)

    Finnerup, Nanna Brix; Sørensen, Leif Hougaard; Biering-Sørensen, Fin;

    2007-01-01

    The mechanisms underlying central pain following spinal cord injury (SCI) are unsettled. The purpose of the present study was to examine differences in spinothalamic tract function below injury level and evoked pain in incomplete SCI patients with neuropathic pain below injury level (central pain...

  4. Depression and Spinal Cord Injury

    Science.gov (United States)

    ... About Us Patient Care Resources Information & Education SCI Empowerment Project Projects & Research FAQ © 2017 University of Washington ... Cord Injury” (PDF - 477KB)] Depression is a common illness that can affect ... or a mental health specialist immediately. Also, inform those around you ...

  5. Vitamin D profile of patients with spinal cord injury and post-stroke hemiplegia: All in the same boat.

    Science.gov (United States)

    Coskun Benlidayi, Ilke; Basaran, Sibel; Seydaoglu, Gulsah; Guzel, Rengin

    2016-04-27

    Patients with spinal cord injury (SCI) and hemiplegia are at risk of fractures partly due to decreased bone mineral density with relation to the low levels of vitamin D. The objective of this study is to evaluate the vitamin D profile of patients with SCI and post-stroke hemiplegia. 25(OH)D levels of patients with SCI and hemiplegia were obtained from the electronic medical record database and compared with age- and sex-matched non-disabled controls. Furthermore, the effect of Functional Ambulation Category (FAC), American Spinal Injury Association (ASIA) level and Brunnstrom's recovery stage, on vitamin D insufficiency, was studied. The study sample consisted of 173 individuals (118 patients and 55 controls). Vitamin D levels and sufficiency rates of the neurologically disabled patients was significantly lower than that of controls (p= 0.000 and p= 0.000, respectively). However, there was no difference between patients with SCI and hemiplegia regarding the 25(OH)D levels and vitamin D insufficiency (p= 0.303 and p= 0.952, respectively). There were no statistically significant differences in vitamin D status by American Spinal Injury Association (ASIA) level and Brunnstrom's score. However, regression analysis revealed that vitamin D insufficiency rate of non-functionally ambulatory (FAC = 0-2) patients was higher than that of functionally ambulatory (FAC = 3-5) ones (p= 0.044). Vitamin D status of patients with neurological disabilities was lower than that of controls. Non-functionally ambulatory patients had higher vitamin D insufficiency rate than functionally ambulatory patients. Preventative measures including adequate supplementation of vitamin D should be directed to neurologically disabled subjects, particularly those with non-functional ambulation.

  6. Influence of Previous Comorbidities and Common Complications on Motor Function after Early Surgical Treatment of Patients with Traumatic Spinal Cord Injury.

    Science.gov (United States)

    Kreinest, Michael; Ludes, Lisa; Biglari, Bahram; Küffer, Maike; Türk, Ansgar; Grützner, Paul A; Matschke, Stefan

    2016-12-15

    The influence of complications and comorbidities on the outcome of patients with traumatic spinal cord injury after early surgery is unclear. The aim of the current study was to analyze the influence of previous comorbidities and common complications on motor function outcome of patients with traumatic spinal cord injury if early surgery was performed. All patients with a traumatic spinal cord injury who were initially surgically treated in our hospital in the period from January 2008 to December 2013 were included in this study. Epidemiological data and previous comorbidities (cardiovascular, pulmonary, metabolic, spinal) were documented. A neurological assessment was performed using the American Spinal Injury Association (ASIA) score. Retrospectively, patients' personal data (age, gender, comorbidities) and clinical data (complications, ASIA score, motor function) were analyzed statistically. A total of 133 patients met the inclusion criteria. The level of spinal cord injury ranged from C3 to L4. Motor function was improved from 51.5 ± 24.8 to 60.1 ± 25.0 (improvement: 25.7%). The most common complications were urinary tract infection and pneumonia. There is a significant relationship between a lack of previous spinal comorbidities and a better outcome in terms of motor function. No other comorbidities or complications showed any effect on motor function outcome. The current study shows that motor function was able to be improved in patients who were given early surgery after a traumatic spinal cord injury. Common complications as well as previous cardiovascular, pulmonary, and metabolic comorbidities do not impair motor function outcome. The final motor function score is reduced if patients have previous spinal comorbidities.

  7. Spinal Cord Injury: Hope through Research

    Science.gov (United States)

    ... recent tetraplegia. Much as in the general population, cardiovascular disease (CVD) is a leading cause of death in persons with spinal cord injury. After the injury, the opportunity to actively exercise large muscles affected by paralysis is limited or ...

  8. Relationship of occupational therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: The SCIRehab Project

    Science.gov (United States)

    Ozelie, Rebecca; Gassaway, Julie; Buchman, Emily; Thimmaiah, Deepa; Heisler, Lauren; Cantoni, Kara; Foy, Teresa; Hsieh, Ching-Hui (Jean); Smout, Randall J.; Kreider, Scott E. D.; Whiteneck, Gale

    2012-01-01

    Background/objective Describe associations of occupational therapy (OT) interventions delivered during inpatient spinal cord injury (SCI) rehabilitation and patient characteristics with outcomes at the time of discharge and 1-year post-injury. Methods Occupational therapists at six inpatient rehabilitation centers documented detailed information about treatment provided. Least squares regression modeling was used to predict outcomes at discharge and 1-year injury anniversary for a 75% subset; models were validated with the remaining 25%. Functional outcomes for injury subgroups (motor complete low tetraplegia and motor complete paraplegia) also were examined. Results OT treatment variables explain a small amount of variation in Functional Independence Measure (FIM) outcomes for the full sample and significantly more in two functionally homogeneous subgroups. For patients with motor complete paraplegia, more time spent in clothing management and hygiene related to toileting was a strong predictor of higher scores on the lower body items of the self-care component of the discharge motor FIM. Among patients with motor complete low tetraplegia, higher scores for the FIM lower body self-care items were associated with more time spent on lower body dressing, manual wheelchair mobility training, and bathing training. Active patient participation during OT treatment sessions also was predictive of FIM and other outcomes. Conclusion OT treatments add to explained variance (in addition to patient characteristics) for multiple outcomes. The impact of OT treatment on functional outcomes is more evident when examining more homogeneous patient groupings and outcomes specific to the groupings. Note This is the third of nine articles in the SCIRehab series. PMID:23318035

  9. Altered spontaneous brain activity in patients with acute spinal cord injury revealed by resting-state functional MRI.

    Directory of Open Access Journals (Sweden)

    Ling Zhu

    Full Text Available Previous neuroimaging studies have provided evidence of structural and functional reorganization of brain in patients with chronic spinal cord injury (SCI. However, it remains unknown whether the spontaneous brain activity changes in acute SCI. In this study, we investigated intrinsic brain activity in acute SCI patients using a regional homogeneity (ReHo analysis based on resting-state functional magnetic resonance imaging.A total of 15 patients with acute SCI and 16 healthy controls participated in the study. The ReHo value was used to evaluate spontaneous brain activity, and voxel-wise comparisons of ReHo were performed to identify brain regions with altered spontaneous brain activity between groups. We also assessed the associations between ReHo and the clinical scores in brain regions showing changed spontaneous brain activity.Compared with the controls, the acute SCI patients showed decreased ReHo in the bilateral primary motor cortex/primary somatosensory cortex, bilateral supplementary motor area/dorsal lateral prefrontal cortex, right inferior frontal gyrus, bilateral dorsal anterior cingulate cortex and bilateral caudate; and increased ReHo in bilateral precuneus, the left inferior parietal lobe, the left brainstem/hippocampus, the left cingulate motor area, bilateral insula, bilateral thalamus and bilateral cerebellum. The average ReHo values of the left thalamus and right insula were negatively correlated with the international standards for the neurological classification of spinal cord injury motor scores.Our findings indicate that acute distant neuronal damage has an immediate impact on spontaneous brain activity. In acute SCI patients, the ReHo was prominently altered in brain regions involved in motor execution and cognitive control, default mode network, and which are associated with sensorimotor compensatory reorganization. Abnormal ReHo values in the left thalamus and right insula could serve as potential biomarkers for

  10. Use of Flexible Cystoscopy to Insert a Foley Catheter over a Guide Wire in Spinal Cord Injury Patients: Special Precautions to be Observed

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2011-01-01

    Full Text Available When urethral catheterisation is difficult or impossible in spinal cord injury patients, flexible cystoscopy and urethral catheterisation over a guide wire can be performed on the bedside, thus obviating the need for emergency suprapubic cystostomy. Spinal cord injury patients, who undergo flexible cystoscopy and urethral catheterisation over a guide wire, may develop potentially serious complications. (1 Persons with lesion above T-6 are susceptible to develop autonomic dysreflexia during cystoscopy and urethral catheterisation over a guide wire; nifedipine 5–10 milligrams may be administered sublingually just prior to the procedure to prevent autonomic dysreflexia. (2 Spinal cord injury patients are at increased risk for getting urine infections as compared to able-bodied individuals. Therefore, antibiotics should be given to patients who get haematuria or urethral bleeding following urethral catheterisation over a guide wire. (3 Some spinal cord injury patients may have a small capacity bladder; in these patients, the guide wire, which is introduced into the urinary bladder, may fold upon itself with the tip of guide wire entering the urethra. If this complication is not recognised and a catheter is inserted over the guide wire, the Foley catheter will then be misplaced in urethra despite using cystoscopy and guide wire.

  11. Pulse low-intensity electromagnetic field as prophylaxis of heterotopic ossification in patients with traumatic spinal cord injury

    Directory of Open Access Journals (Sweden)

    Đurović Aleksandar

    2009-01-01

    Full Text Available Background/Aim. Heterotopic ossification (HO is an important complication of head and spinal cord injuries (SCI. Pulse low-intensity electromagnetic field (PLIMF therapy increases blood flow to an area of pain or inflammation, bringing more oxygen to that area and helps to remove toxic substances. The aim of this study was to determine the effect of PLIMF as prophylaxis of HO in patients with SCI. Methods. This prospective random control clinical study included 29 patients with traumatic SCI. The patients were randomly divided into experimental (n = 14 and control group (n = 15. The patients in the experimental group, besides exercise and range of motion therapy, were treated by PLIMF of the following characteristics: induction of 10 mT, frequency of 25 Hz and duration of 30 min. Pulse low-intensity electromagnetic field therapy started in the 7th week after the injury and lasted 4 weeks. The presence or absence of HO around the patients hips we checked by a plane radiography and Brookers classification. Functional capabilities and motor impairment were checked by Functional Independent Measure (FIM, Barthel index and American Spinal Injury Association (ASIA impairment class. Statistic analysis included Kolmogorov-Smirnov test, Shapiro-Wilk test, Mann Whitney Exact test, Exact Wilcoxon signed rank test and Fischer Exact test. Statistical significance was set up to p < 0.05. Results. At the end of the treatment no patient from the experimental group had HO. In the control group, five patients (33.3% had HO. At the end of the treatment the majority of the patients from the experimental group (57.14% moved from ASIA-A to ASIA-B class. Conclusion. Pulse low-intensity electromagnetic field therapy could help as prophylaxis of HO in patients with traumatic SCI.

  12. Knowledge discovery about quality of life changes of spinal cord injury patients: clustering based on rules by states.

    Science.gov (United States)

    Gibert, Karina; García-Rudolph, Alejandro; Curcoll, Lluïsa; Soler, Dolors; Pla, Laura; Tormos, José María

    2009-01-01

    In this paper, an integral Knowledge Discovery Methodology, named Clustering based on rules by States, which incorporates artificial intelligence (AI) and statistical methods as well as interpretation-oriented tools, is used for extracting knowledge patterns about the evolution over time of the Quality of Life (QoL) of patients with Spinal Cord Injury. The methodology incorporates the interaction with experts as a crucial element with the clustering methodology to guarantee usefulness of the results. Four typical patterns are discovered by taking into account prior expert knowledge. Several hypotheses are elaborated about the reasons for psychological distress or decreases in QoL of patients over time. The knowledge discovery from data (KDD) approach turns out, once again, to be a suitable formal framework for handling multidimensional complexity of the health domains.

  13. The effect of virtual visual feedback on supernumerary phantom limb pain in a patient with high cervical cord injury: a single-case design study.

    Science.gov (United States)

    Katayama, Osamu; Iki, Hidemasa; Sawa, Shunji; Osumi, Michihiro; Morioka, Shu

    2015-01-01

    We characterized the effect of virtual visual feedback (VVF) on supernumerary phantom limb pain (SPLP) in a patient with high cervical cord injury. The subject was a 22-year-old man diagnosed with complete spinal cord injury (level C2) approximately 5 years ago. We applied the ABA'B' single-case design and set phases B and B' as intervention phases for comparison. SPLP significantly improved in comparison of phase A with phase B and phase A with phase B'. We suggest that VVF reduces SPLP and the effect lasts after VVF.

  14. Muscle after spinal cord injury

    DEFF Research Database (Denmark)

    Biering-Sørensen, Bo; Kristensen, Ida Bruun; Kjaer, Michael;

    2009-01-01

    The morphological and contractile changes of muscles below the level of the lesion after spinal cord injury (SCI) are dramatic. In humans with SCI, a fiber-type transformation away from type I begins 4-7 months post-SCI and reaches a new steady state with predominantly fast glycolytic IIX fibers...... years after the injury. There is a progressive drop in the proportion of slow myosin heavy chain (MHC) isoform fibers and a rise in the proportion of fibers that coexpress both the fast and slow MHC isoforms. The oxidative enzymatic activity starts to decline after the first few months post-SCI. Muscles...... from individuals with chronic SCI show less resistance to fatigue, and the speed-related contractile properties change, becoming faster. These findings are also present in animals. Future studies should longitudinally examine changes in muscles from early SCI until steady state is reached in order...

  15. Economic assessment of pressure sore prevention using a computerized mattress system in patients with spinal cord injury.

    Science.gov (United States)

    Catz, Amiram; Zifroni, Avi; Philo, Ora

    2005-11-15

    To assess the economic profitability of a new computerized mattress system in patients with spinal cord injuries (SCI) by comparison with two other alternatives, as an example of the use of a quantitative approach for decision-making in choosing between alternatives for sore prevention. The cost of achieving one day without signs of impending pressure sore was compared between the alternative options using cost minimization analysis. Savings in nursing costs for the three options were calculated for cost-benefit analysis. A foam mattress system is significantly cheaper than the other examined alternatives, and if the nursing manpower cost is constant and the nursing staff is capable of performing sufficient repositioning, this system would achieve the desired medical outcome at a minimal cost. However, if the nursing staff cannot perform sufficient repositioning, or if the use of nursing manpower can be adjusted to the actual need, then it is the computerized mattress system that achieves the desired outcome at the minimal cost. In this case, less than 20 New Israeli Shekels (NIS) per day spent on the equipment save NIS 45 per day in labor costs. The economic evaluation indicates that the computerized mattress system is advisable for patients with SCI who require assistance for repositioning, but its profitability depends on the employment terms of the nursing manpower. In addition, other possible alternative pressure management systems should be examined, and additional research may be needed to determine the optimal combination of such systems for a spinal cord rehabilitation department.

  16. Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients.

    NARCIS (Netherlands)

    Middendorp, J.J. van; Hosman, A.J.F.; Pouw, M.H.; Meent, H. van de

    2009-01-01

    STUDY DESIGN: Prospective multicenter longitudinal cohort study. OBJECTIVE: To validate the prognostic value of the acute phase sacral sparing measurements with regard to chronic phase-independent ambulation in patients with traumatic spinal cord injury (SCI). SETTING: European Multicenter Study of

  17. 脊髓损伤并瘫痪患者心理护理探讨%Psychological nursing of patients with spinal cord injury contine paralysis.

    Institute of Scientific and Technical Information of China (English)

    梁勇东

    2012-01-01

    Objective:To disscuss the psychological care of patients with spinal cord injury and paralysis. Methods:18 patients with spinal cord injury and paralysis occur at different times of fear, anxiety, anger, depression and other psychological conditions were appropriate psychological care. Results:18 cases of patients with spinal cord injuries and paralysis can eliminate fear, anxiety, anger, depression and other negative expressing emotions actively cooperate with treatment and care, without adverse events. Conclusion: Psychological care is spinal cord injury patients the right to face a new life, a powerful disease - fighting protection.%目的:探讨脊髓损伤并瘫痪患者的心理护理.方法:对18例脊髓损伤并瘫痪患者不同时期出现的恐惧、焦虑、愤怒、抑郁等心理状况进行了相应的心理护理.结果:18例脊髓损伤并瘫痪患者能消除恐惧、焦虑、愤怒、抑郁等不良情绪,积极配合治疗和护理,无不良事件发生.结论:心理护理是脊髓损伤患者正确面对新生活,战胜疾病的有力保障.

  18. Effect of high-frequency repetitive transcranial magnetic stimulation on motor cortical excitability and sensory nerve conduction velocity in subacute-stage incomplete spinal cord injury patients.

    Science.gov (United States)

    Cha, Hyun Gyu; Ji, Sang-Goo; Kim, Myoung-Kwon

    2016-07-01

    [Purpose] The aim of the present study was to determine whether repetitive transcranial magnetic stimulation can improve sensory recovery of the lower extremities in subacute-stage spinal cord injury patients. [Subjects and Methods] This study was conducted on 20 subjects with diagnosed paraplegia due to spinal cord injury. These 20 subjects were allocated to an experimental group of 10 subjects that underwent active repetitive transcranial magnetic stimulation or to a control group of 10 subjects that underwent sham repetitive transcranial magnetic stimulation. The SCI patients in the experimental group underwent active repetitive transcranial magnetic stimulation and conventional rehabilitation therapy, whereas the spinal cord injury patients in the control group underwent sham repetitive transcranial magnetic stimulation and conventional rehabilitation therapy. Participants in both groups received therapy five days per week for six-weeks. Latency, amplitude, and sensory nerve conduction velocity were assessed before and after the six week therapy period. [Results] A significant intergroup difference was observed for posttreatment velocity gains, but no significant intergroup difference was observed for amplitude or latency. [Conclusion] repetitive transcranial magnetic stimulation may be improve sensory recovery of the lower extremities in subacute-stage spinal cord injury patients.

  19. Influence of patients' age on functional recovery after transplantation of olfactory ensheathing cells into injured spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    黄红云; 陈琳; 王洪美; 修波; 李炳辰; 王锐; 张健; 张峰; 顾征; 李荧; 宋英伦; 郝伟; 潘树义; 孙君昭

    2003-01-01

    Objective To evaluate the restoration of function after spinal cord injury (SCI) in patients of different ages who have underwent intraspinal transplantation of olfactory ensheathing cells (OECs). Methods One hundred and seventy-one SCI patients were included in this study. Of them, 139 were male and 32 were female, with age ranging from 2 to 64 years (mean, 34.9 years). In all SCI patients the lesions were injected at the time of operation with OECs. According to their ages, the patients were divided into 5 groups: ≤20 years group (n=9), 21-30 years group (n=54), 31-40 years group (n=60), 41-50 years group (n=34) and>51 years group (n=14). The spinal cord function was assessed based on the American Spinal Injury Association (ASIA) Classification System before and 2-8 weeks after OECs transplantation. One-way ANOVA and q test were used for statistical analysis, and the data were expressed as mean±SD.Results After surgery, the motor scores increased by 5.2±4.8, 8.6±8.0, 8.3±8.8, 5.7±7.3 and 8.2±7.6 in 5 age groups respectively (F=1.009, P=0.404); light touch scores increased by 13.9±8.1, 15.5±14.3, 12.0±14.4, 14.1±18.5 and 24.8±25.3 respectively (F=1.837, P=0.124); and pin prick scores increased by 11.1±7.9, 17.2±14.3, 13.2±11.8, 13.6±13.9 and 25.4±24.3 respectively (F=2.651, P=0.035). Restoration of pin prick in >51 years group was better than other age groups except 21-30 years group. Conclusion OECs transplantation can improve the neurological function of spinal cord of SCI patients regardless of their ages. Further research into the long-term outcomes of the treatment will be required.

  20. Stabilizing transpelvic prosthetic socket for a patient with spinal cord injury sustaining right partial hemipelvectomy and left hip disarticulation.

    Science.gov (United States)

    Nakanishi, Yoshie; Watanabe, Tetsuro; Ikeda, Atsushi; Wada, Futoshi; Hachisuka, Kenji

    2012-06-01

    A bucket-type transpelvic socket was fabricated for a man with paraplegia from spinal cord injury, who underwent right partial pelvic amputation and left hip disarticulation. His main problem was inability to sit due to asymmetrical pelvic shape. We prescribed a transpelvic prosthetic socket to enable him to sit again. The socket consisted of a dual structure: a hard frame and soft liner. The main features of the socket were redistribution of pressure to prevent recurrence of pressure ulcer, and a slightly backward tilt to maintain a comfortable sitting position. In addition, the socket had small air holes for ventilation; a big window in the abdominal area for management of stoma and cystostomy; and two straps for donning it independently. In addition, we confirmed the internal pressure distribution in the socket by a pressure mapping system to prevent reoccurrence of skin trouble. Finally, the patient regained independence in activities of daily living, including driving a car, after two months of rehabilitative training.

  1. Invasive and non-invasive brain stimulation for treatment of neuropathic pain in patients with spinal cord injury: a review.

    Science.gov (United States)

    Nardone, Raffaele; Höller, Yvonne; Leis, Stefan; Höller, Peter; Thon, Natasha; Thomschewski, Aljoscha; Golaszewski, Stefan; Brigo, Francesco; Trinka, Eugen

    2014-01-01

    Past evidence has shown that invasive and non-invasive brain stimulation may be effective for relieving central pain. To perform a topical review of the literature on brain neurostimulation techniques in patients with chronic neuropathic pain due to traumatic spinal cord injury (SCI) and to assess the current evidence for their therapeutic efficacy. A MEDLINE search was performed using following terms: "Spinal cord injury", "Neuropathic pain", "Brain stimulation", "Deep brain stimulation" (DBS), "Motor cortex stimulation" (MCS), "Transcranial magnetic stimulation" (TMS), "Transcranial direct current stimulation" (tDCS), "Cranial electrotherapy stimulation" (CES). Invasive neurostimulation therapies, in particular DBS and epidural MCS, have shown promise as treatments for neuropathic and phantom limb pain. However, the long-term efficacy of DBS is low, while MCS has a relatively higher potential with lesser complications that DBS. Among the non-invasive techniques, there is accumulating evidence that repetitive TMS can produce analgesic effects in healthy subjects undergoing laboratory-induced pain and in chronic pain conditions of various etiologies, at least partially and transiently. Another very safe technique of non-invasive brain stimulation - tDCS - applied over the sensory-motor cortex has been reported to decrease pain sensation and increase pain threshold in healthy subjects. CES has also proved to be effective in managing some types of pain, including neuropathic pain in subjects with SCI. A number of studies have begun to use non-invasive neuromodulatory techniques therapeutically to relieve neuropathic pain and phantom phenomena in patients with SCI. However, further studies are warranted to corroborate the early findings and confirm different targets and stimulation paradigms. The utility of these protocols in combination with pharmacological approaches should also be explored.

  2. Dual diagnosis: traumatic brain injury with spinal cord injury.

    Science.gov (United States)

    Kushner, David S; Alvarez, Gemayaret

    2014-08-01

    Spinal cord injury (SCI) patients should be assessed for a co-occurring traumatic brain injury (TBI) on admission to a rehabilitation program. Incidence of a dual diagnosis may approach 60% with certain risk factors. Diagnosis of mild-moderate severity TBIs may be missed during acute care hospitalizations of SCI. Neuropsychological symptoms of a missed TBI diagnosis may be perceived during rehabilitation as noncompliance, inability to learn, maladaptive reactions to SCI, and poor motivation. There are life-threatening and quality-of-life-threatening complications of TBI that also may be missed if a dual diagnosis is not made.

  3. Clinical trial of a method for confirming the effects of spinal anesthesia in patients with spinal cord injury.

    Science.gov (United States)

    Takatsuki, Akiko; Ohtsuka, Masahide

    2012-12-01

    In this case series study, we prospectively examined whether it might be possible to check the effect of spinal anesthesia (SA), based on the disappearance of lower extremity reflexes and spasticity, in patients with spinal cord injury (SCI), in whom the effect cannot be confirmed by the pinprick test or by using the Bromage scale. In 40 patients with chronic, clinically complete cervical SCI who were scheduled to receive SA, pre-anesthetic examination revealed that the Babinski sign, patellar tendon reflex, and spasticity (assessed using the Ashworth scale) were all positive in 31 patients, while two of these three pre-anesthetic assessment parameters were positive in eight patients. The effect of SA in these 39 patients (97.5 %) was confirmed by demonstrating the absence of both the Babinski sign and patellar tendon reflex and loss of spasticity after SA. Our results suggested that the effect of SA can be confirmed by the disappearance of the Babinski sign and patellar tendon reflex and loss of spasticity in most patients with complete cervical SCI, although determination of the level of the block is difficult. In conclusion, loss of the Babinski sign, patellar tendon reflex, and spasticity might be useful for checking the effect of SA in cervical SCI patients.

  4. Team size in spinal cord injury inpatient rehabilitation and patient participation in therapy sessions: the SCIRehab project.

    Science.gov (United States)

    Dijkers, Marcel P; Faotto, Rose-Marie

    2012-11-01

    Rehabilitation teams generally are described as consisting of a single representative of 6-8 disciplines, but research suggests that the number of individuals involved may be much larger. This study aimed to determine the size of teams in spinal cord injury (SCI) rehabilitation, and the effect of team size on patients' active participation in their treatment sessions. Prospective observational study. Six SCI rehabilitation centers. A total of 1376 patients with traumatic SCI admitted for first rehabilitation. Not applicable. Number of treatment sessions, by discipline and overall clinician rating of active participation of the patient; Treatment Concentration Index (TCI) calculated as Σp(k)(2) (where p refers to the proportion of treatment sessions delivered by team member k). The average patient was treated by 39.3 different clinicians. The numbers were especially high for physical therapy (mean: 8.8), occupational therapy (7.2), and nursing (16.1). TCI was 0.08 overall; it varied by discipline. TCI was negatively correlated with length of stay, except for psychology. Participation ratings were minimally affected by the number of sessions the patient and the therapist had worked together. In SCI rehabilitation, teams are at least as large as suggested by previous research. However, this may not mean lack of familiarity of patient and therapist with one another, or alternatively, the possibly weak therapeutic alliance does not affect the patients' active participation in their sessions. Further research is needed to determine whether there are negative effects on rehabilitation outcomes.

  5. Advanced Restoration Therapies in Spinal Cord Injury

    Science.gov (United States)

    2015-07-01

    including but not limited to traumatic brain injury , Alzheimer’s disease, cerebrovascular insults, and leukodystrophy. SECTION 2 – KEYWORDS Spinal...Spinal Cord Injury Annual Report to change our proposed anesthesia method from isofluorane to medetomidine. We have made the appropriate changes and...McKinley, W., and Tulsky, D. (2004). Late neurologic recovery after traumatic spinal cord injury . Arch Phys Med Rehabil 85, 1811-1817. Lorenz, D.J

  6. Galactorrhea: a complication of spinal cord injury.

    Science.gov (United States)

    Yarkony, G M; Novick, A K; Roth, E J; Kirschner, K L; Rayner, S; Betts, H B

    1992-09-01

    Galactorrhea, a secretion of milk or milk-like products from the breast in the absence of parturition, has been reported to occur in women with spinal cord injuries in association with amenorrhea and hyperprolactinemia. Four cases of galactorrhea in association with spinal cord injury are reported. Galactorrhea developed in four spinal cord injured women who had thoracic paraplegia. The onset of galactorrhea was from one month to five months after injury. Although the onset of galactorrhea may have been related to prescribed medications in all four cases, insufficient data exist to draw conclusions. The three women whose galactorrhea persisted declined treatment and galactorrhea continuing for more than two years in one instance. We conclude that galactorrhea with or without amenorrhea may develop after a spinal cord injury and that spinal cord injured women may have an enhanced sensitivity to medication-induced galactorrhea.

  7. Effects of orthotic therapeutic electrical stimulation in the treatment of patients with paresis associated with acute cervical spinal cord injury: a randomized control trial.

    Science.gov (United States)

    Iwahashi, K; Hayashi, T; Watanabe, R; Nishimura, A; Ueta, T; Maeda, T; Shiba, K

    2017-06-27

    A randomized controlled trial. To determine the effects of orthotic therapeutic electrical stimulation (TES) on the hand in patients with paresis associated with acute cervical spinal cord injury. Spinal Injuries Center, Fukuoka, Japan. The study included patients treated for spinal cord injuries (Frankel classification, grades B and C) at our institution within 1 week post injury between May 2011 and December 2014. The patients were allocated randomly to TES and control groups at the time of admission and underwent TES+conventional training or conventional training alone, respectively. Both hands of each patient were treated in the same way. The primary outcome was total passive motion (TPM) of the fingers (degrees). The secondary outcomes were edema (cm) and the upper-extremity motor scores of the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI). After randomization, outcomes were assessed at 1 week, 1 month and 3 months post injury in both groups. Twenty-nine individuals were assessed at 3 months (15, TES; 14, control). There were no significant between-group differences for TPM of the fingers, edema and upper-extremity motor scores at 1 week, 1 month and 3 months after injury, although TPM of the fingers tended to be lower in the control group. It is unclear from the results of this study whether TES has a therapeutic effect on TPM, edema or the upper-extremity motor score of the ISNCSCI. The results of this study provide useful data for future meta-analyses.Spinal Cord advance online publication, 27 June 2017; doi:10.1038/sc.2017.74.

  8. Effectiveness of automated locomotor training in patients with acute incomplete spinal cord injury: A randomized controlled multicenter trial

    Directory of Open Access Journals (Sweden)

    Bastiaenen Carolien

    2011-05-01

    Full Text Available Abstract Background A large proportion of patients with spinal cord injury (SCI regain ambulatory function. However, during the first 3 months most of the patients are not able to walk unsupported. To enable ambulatory training at such an early stage the body weight is partially relieved and the leg movements are assisted by two therapists. A more recent approach is the application of robotic based assistance which allows for longer training duration. From motor learning science and studies including patients with stroke, it is known that training effects depend on the duration of the training. Longer trainings result in a better walking function. The aim of the present study is to evaluate if prolonged robot assisted walking training leads to a better walking outcome in patients with incomplete SCI and whether such training is feasible or has undesirable effects. Methods/Design Patients from multiple sites with a subacute incomplete SCI and who are not able to walk independently will be randomized to either standard training (3-5 sessions per week, session duration maximum 25 minutes or an intensive training (3-5 sessions per week, session duration minimum 50 minutes. After 8 weeks of training and 4 months later the walking ability, the occurrence of adverse events and the perceived rate of exertion as well as the patients' impression of change will be compared between groups. Trial registration This study is registered at clinicaltrials.gov, identifier: NCT01147185.

  9. Magnetic resonance imaging of acute spinal-cord injury

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Hideki; Nakagawa, Hiroshi; Yamada, Takahisa; Iwata, Kinjiro (Aichi Medical Univ., Nagakute (Japan)); Okumura, Terufumi; Hoshino, Daisaku

    1992-04-01

    Magnetic resonance imaging (MRI) provides a noninvasive and very important method of investigating spinal-cord injuries. By means of MRI we examined 36 patients with spinal injuries, 34 of them in the acute stage. 19 cases had complete spinal-cord injury with paraplegia, while 17 cases had incomplete spinal-cord injury. MRI showed the injured spinal-cord in the acute stage to be partially swollen, with a high signal intensity in the T[sub 2]-weighted images. In the chronic stage, the injured cord may show atrophic changes with a post-traumatic cavity or myelomalacia, which appears as a high-signal-intensity lesion in the T[sub 2]-weighted images and as a low-signal intensity in the T[sub 1]-weighted images. The cases with complete spinal injuries showed a high signal intensity at the wide level, and these prognoses were poor. The cases with incomplete injuries showed normal findings or a high-signal-intensity spot. In the Gd-DTPA enhanced images, the injured cords were enhanced very well in the subchronic stage. MRI is thus found to be useful in the diagnosis of spinal injuries; it also demonstrates a potential for predicting the neurological prognosis. (author).

  10. Functional status in patients with spinal cord injury: a new standardized measurement scale. Gruppo Interdisciplinare Valutazione Interventi Riabilitativi.

    Science.gov (United States)

    Taricco, M; Apolone, G; Colombo, C; Filardo, G; Telaro, E; Liberati, A

    2000-09-01

    To report on the validation process of a new functional assessment scale (Valutazione Funzionale Mielolesi [VFM]) for patients with spinal cord injury (SCI). Prospective study testing for the VFM in a sample of patients with SCI to evaluate the scale characteristics in terms of psychometric and clinical validity. Eight SCI units located in northern Italy. One hundred patients were recruited and followed up for 18 months. Seventy-seven subjects were men, subjects' mean age was 37 years, 67 were paraplegic, and for 81 their SCI was of traumatic etiology. VFM's characteristics are described using estimates of construct and criterion validity (estimates of the strength and direction of associations between different VFM tasks and between VFM and other medical and nonmedical variables). The Barthel index was used as concurrent and independent measure. VFM met all psychometric criteria usually recommended and, at least in the current sample, was found to be strongly correlated with independent clinical variables (diagnosis and lesion level) and with the Barthel index. Moreover, most of the domains were able to document large and significant changes over time. VFM is a reliable and valid tool that can be used confidently in the rehabilitation setting for patients with SCI to screen for functional problems and monitor changes in patients' functional status and impact of rehabilitation.

  11. Nanomedicine for treating spinal cord injury

    Science.gov (United States)

    Tyler, Jacqueline Y.; Xu, Xiao-Ming; Cheng, Ji-Xin

    2013-09-01

    Spinal cord injury results in significant mortality and morbidity, lifestyle changes, and difficult rehabilitation. Treatment of spinal cord injury is challenging because the spinal cord is both complex to treat acutely and difficult to regenerate. Nanomaterials can be used to provide effective treatments; their unique properties can facilitate drug delivery to the injury site, enact as neuroprotective agents, or provide platforms to stimulate regrowth of damaged tissues. We review recent uses of nanomaterials including nanowires, micelles, nanoparticles, liposomes, and carbon-based nanomaterials for neuroprotection in the acute phase. We also review the design and neural regenerative application of electrospun scaffolds, conduits, and self-assembling peptide scaffolds.

  12. Hyperbaric oxygen therapy improves local microenvironment after spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    Yang Wang; Shuquan Zhang; Min Luo; Yajun Li

    2014-01-01

    Clinical studies have shown that hyperbaric oxygen therapy improves motor function in patients with spinal cord injury. In the present study, we explored the mechanisms associated with the recovery of neurological function after hyperbaric oxygen therapy in a rat model of spinal cord injury. We established an acute spinal cord injury model using a modiifcation of the free-falling object method, and treated the animals with oxygen at 0.2 MPa for 45 minutes, 4 hours after injury. The treatment was administered four times per day, for 3 days. Compared with model rats that did not receive the treatment, rats exposed to hyperbaric oxygen had fewer apoptotic cells in spinal cord tissue, lower expression levels of aquaporin 4/9 mRNA and protein, and more NF-200 positive nerve ifbers. Furthermore, they had smaller spinal cord cavities, rapid recovery of somatosensory and motor evoked potentials, and notably better recovery of hindlimb motor function than model rats. Our ifndings indicate that hyperbaric oxygen therapy reduces apop-tosis, downregulates aquaporin 4/9 mRNA and protein expression in injured spinal cord tissue, improves the local microenvironment for nerve regeneration, and protects and repairs the spinal cord after injury.

  13. Nanomedicine strategies for treatment of secondary spinal cord injury.

    Science.gov (United States)

    White-Schenk, Désirée; Shi, Riyi; Leary, James F

    2015-01-01

    Neurological injury, such as spinal cord injury, has a secondary injury associated with it. The secondary injury results from the biological cascade after the primary injury and affects previous uninjured, healthy tissue. Therefore, the mitigation of such a cascade would benefit patients suffering a primary injury and allow the body to recover more quickly. Unfortunately, the delivery of effective therapeutics is quite limited. Due to the inefficient delivery of therapeutic drugs, nanoparticles have become a major field of exploration for medical applications. Based on their material properties, they can help treat disease by delivering drugs to specific tissues, enhancing detection methods, or a mixture of both. Incorporating nanomedicine into the treatment of neuronal injury and disease would likely push nanomedicine into a new light. This review highlights the various pathological issues involved in secondary spinal cord injury, current treatment options, and the improvements that could be made using a nanomedical approach.

  14. [Mortality structure following spine and spinal cord injuries].

    Science.gov (United States)

    Bazilevskaia, Z V; Golovnykh, L L; Kirkinskaia, T A

    1980-01-01

    In a group of 520 patients with injury to the spine and spinal cord 125 died within 10 years. The highest fatality rate (76.0 +/0 3.8) is recorded in the first year after the injury. In the following 10 years the fatality rate was uniform and ranged between 1.6 and 4.1%. This value increases with the patient's age, the severity of the spinal cord injury, and the degree of damage to the spinal ligamento-bursal apparatus. Among the total number of injured, 76% have a survival period of more than 10 years.

  15. Cervical spinal cord injury without radiological abnormality in adults.

    Directory of Open Access Journals (Sweden)

    Bhatoe H

    2000-07-01

    Full Text Available Spinal cord injury occurring without concomitant radiologically demonstrable trauma to the skeletal elements of the spinal canal rim, or compromise of the spinal canal rim without fracture, is a rare event. Though documented in children, the injury is not very well reported in adults. We present seventeen adult patients with spinal cord injury without accompanying fracture of the spinal canal rim, or vertebral dislocation, seen over seven years. None had preexisting spinal canal stenosis or cervical spondylosis. Following trauma, these patients had weakness of all four limbs. They were evaluated by MRI (CT scan in one patient, which showed hypo / isointense lesion in the cord on T1 weighted images, and hyperintensity on T2 weighted images, suggesting cord contusion or oedema. MRI was normal in two patients. With conservative management, fifteen patients showed neurological improvement, one remained quadriplegic and one died. With increasing use of MRI in the evaluation of traumatic myelopathy, such injuries will be diagnosed more often. The mechanism of injury is probably acute stretching of the cord as in flexion and torsional strain. Management is essentially conservative and prognosis is better than that seen in patients with fracture or dislocation of cervical spine.

  16. Sexual and reproductive function in spinal cord injury and spinal surgery patients

    Directory of Open Access Journals (Sweden)

    Theodore H. Albright

    2015-09-01

    Full Text Available Sexual and reproductive health is important quality of life outcomes, which can have a major impact on patient satisfaction. Spinal pathology arising from trauma, deformity, and degenerative disease processes may be detrimental to sexual and reproductive function. Furthermore, spine surgery may impact sexual and reproductive function due to post-surgical mechanical, neurologic, and psychological factors. The aim of this paper is to provide a concise evidence-based review on the impact that spine surgery and pathology can have on sexual and reproductive function. A review of published literature regarding sexual and reproductive function in spinal injury and spinal surgery patients was performed. We have found that sexual and reproductive dysfunction can occur due to numerous etiological factors associated with spinal pathology. Numerous treatment options are available for those patients, depending on the degree of dysfunction. Spine surgeons and non-operative healthcare providers should be aware of the issues surrounding sexual and reproductive function as related to spine pathology and spine surgery. It is important for spine surgeons to educate their patients on the operative risks that spine surgery encompasses with regard to sexual dysfunction, although current data examining these topics largely consists of level IV data.

  17. Double-level Incomplete Spinal Cord Injuries: A case report

    Directory of Open Access Journals (Sweden)

    Saeed Bin Ayaz

    2014-04-01

    Full Text Available Brown-Séquard Syndrome is a type of Incomplete Spinal Cord Injury characterized by a relatively greater ipsilateral loss of proprioception and motor function, with contralateral loss of pain and temperature sensations. The residual deficits in balance produced by such injury may render a person liable to fall that may result in vertebral fracture and another injury to the spinal cord. We present here a case who initially had Brown-Séquard Syndrome due to penetrating knife injury to the neck and later on developed Cauda Equina Syndrome (another Incomplete Spinal Cord Injury due to fractured LV1 following a fall. The fracture was fixed through Pedicle Screws and the patient underwent effective rehabilitation to gain maximum achievable independence in functional activities. [Cukurova Med J 2014; 39(2.000: 392-398

  18. Respostas cardio-respiratórias em pacientes com traumatismo raquimedular Cardiorespiratory responses of patients with spinal cord injuries

    Directory of Open Access Journals (Sweden)

    Fernanda Rossi Paolillo

    2005-01-01

    Full Text Available O objetivo desta pesquisa foi investigar as variáveis cardio-respiratórias (Pa, FC, VO2, VCO2 e Ve durante a Estimulação Elétrica Neuromuscular (EENM do quadríceps em portadores de lesão medular. Participaram da pesquisa dez pacientes (cinco paraplégicos e cinco tetraplégicos. O protocolo do teste consistiu em 10 minutos de repouso, 20 minutos de EENM dos quadriceps e 10 minutos de recuperação. Durante a EENM foram constatados baixos valores de VO2 e VCO2. Os paraplégicos apresentaram rápida cinética dos gases e os tetraplégicos lenta cinética dos gases. Houve o aumento da Pa sistólica e da FC. Ainda, os valores das variáveis cardio-respiratórias foram inversamente relatadas para o nível de lesão, ou seja, quanto maior o nível de lesão, menor os valores. Portanto, a maioria dos pacientes apresentaram algumas limitações nas respostas cardio-respiratórias, indicando realização de exercício exaustivo, mas apresentaram capacidade de realização de exercício induzido artificialmente, possivelmente devido aos benefícios da EENM.The objective of this study was to investigate cardiorespiratory responses (Heart Rate, Blood Pressure, VO2, VCO2 e Ve to Neuromuscular Electrical Stimulation (NMES of the quadriceps in patients with spinal cord injury. Ten patients (five paraplegics and five tetraplegics participated in this study. The protocol of the test consisted of ten minutes of rest, twenty minutes of NMES of the quadriceps and ten minutes of recovery. The findings in this study indicated that, during NMES, the patients demonstrated low levels of VO2 and VCO2 and slow gas kinetics for tetraplegic individuals, and a fast gas kinetics for paraplegic individuals. Moreover, there were increases in blood pressure and heart rate. Cardiorespiratory responses increased with descending spinal cord injury level, meaning that the more severe the lesion, the lower the values. Therefore, most of the patients presented some limitations

  19. Outbreak caused by Proteus mirabilis isolates producing weakly expressed TEM-derived extended-spectrum β-lactamase in spinal cord injury patients with recurrent bacteriuria.

    Science.gov (United States)

    Cremet, Lise; Bemer, Pascale; Rome, Joanna; Juvin, Marie-Emmanuelle; Navas, Dominique; Bourigault, Celine; Guillouzouic, Aurelie; Caroff, Nathalie; Lepelletier, Didier; Asseray, Nathalie; Perrouin-Verbe, Brigitte; Corvec, Stephane

    2011-12-01

    We performed a retrospective extended-spectrum β-lactamase (ESBL) molecular characterization of Proteus mirabilis isolates recovered from urine of spinal cord injury patients. A incorrectly detected TEM-24-producing clone and a new weakly expressed TEM-derived ESBL were discovered. In such patients, ESBL detection in daily practice should be improved by systematic use of a synergy test in strains of P. mirabilis resistant to penicillins.

  20. Systemic vascular resistance is increased and associated with accelerated arterial stiffening change in patients with chronic cervical spinal cord injury.

    Science.gov (United States)

    Huang, S C; May-Kuen Wong, A; Lien, H Y; Fuk-Tan Tang, S; Fu, T C; Lin, Y; Wang, J S

    2013-02-01

    Despite of stiffening change of conduit arteries, how total peripheral resistance (TPR) is adapted to chronic spinal cord injury (SCI) remains unclear. To investigate how chronic cervical SCI influences hemodynamic characteristics Cross-sectional, case-control study. Rehabilitation department in the tertiary medical center. Twenty-one male patients with traumatic SCI resulting from cervical spine fracture were recruited. The injury occurred three to 289 months (46 months in average) previously. Twenty-one healthy male participants with matched age and body mass index were enrolled as control group. The subjects were asked to maintain supine rest (SR) and then head-up tilt (HUT) at 60 degree for five minutes, respectively. A novel noninvasive bio-reactance device was employed to measure cardiac hemodynamics, whereas heart rate variability was used to determine cardiac autonomic activity. Additionally, the digital volume pulse analysis was applied to calculate arterial stiffness index (SI) and arteriolar reflection index (RI). SCI patients revealed less stroke volume and cardiac output (CO), as well as, greater total peripheral resistance (TPR) and SI during SR than normal subjects did. Moreover, the positive correlation between TPR and SI was observed in SCI patients rather than normal subjects. In SCI patients, HUT (1) markedly decreased TPR while CO and cardio-acceleration responses remained intact and (2) decreased HF power value but failed to change LF/HF ratio. Furthermore, the degree of orthostatic hypotension was correlated with the TPRHUT/TPRSR ratio but not the COHUT/COSR ratio. Chronic cervical SCI leads to a progressively accelerated increase in vascular stiffness, which is associated with increase in systemic vascular resistance. Furthermore, the cervical SCI-related orthostatic hypotension lies in the impairment of vasoconstriction without cardiac dysfunction. Clinical Rehabilitation Impact. SI, rather than blood pressure, reflects not only

  1. Functioning and Disability Analysis of Patients with Traumatic Brain Injury and Spinal Cord Injury by Using the World Health Organization Disability Assessment Schedule 2.0

    Directory of Open Access Journals (Sweden)

    Chia-Ying Kuo

    2015-04-01

    Full Text Available The purpose of this study is to compare traumatic brain injuries (TBI and spinal cord injuries (SCI patients’ function and disability by using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0; and to clarify the factors that contribute to disability. We analyzed data available between September 2012 and August 2013 from Taiwan’s national disability registry which is based on the International Classification of Functioning, Disability, and Health (ICF framework. Of the 2664 cases selected for the study, 1316 pertained to TBI and 1348 to SCI. A larger percentage of patients with TBI compared with those with SCI exhibited poor cognition, self-care, relationships, life activities, and participation in society (all p < 0.001. Age, sex, injury type, socioeconomic status, place of residence, and severity of impairment were determined as factors that independently contribute to disability (all p < 0.05. The WHODAS 2.0 is a generic assessment instrument which is appropriate for assessing the complex and multifaceted disability associated with TBI and SCI. Further studies are needed to validate the WHODAS 2.0 for TBI and SCI from a multidisciplinary perspective.

  2. Body image distortions following spinal cord injury

    National Research Council Canada - National Science Library

    Fuentes, Christina T; Pazzaglia, Mariella; Longo, Matthew R; Scivoletto, Giorgio; Haggard, Patrick

    2013-01-01

    Following spinal cord injury (SCI) or anaesthesia, people may continue to experience feelings of the size, shape and posture of their body, suggesting that the conscious body image is not fully determined by immediate sensory signals...

  3. APOPTOSIS AFTER SPINAL CORD INJURY IN RATS

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective To confirm the role played by apoptosis in spinal cord injury. Methods 36 rats models of spinal cord injury were made by Allen method. Histological examinations using HE staining and in situ end-labeling were used to observe apoptosis in spinal cord tissues from 1h to 21d after injury. Results HE staining sections showed hemorrhage and necrosis, neuronal degeneration and gliai cell proliferation. In situ end-labeling sections showed the appearance of apoptosis in both gray and white matter as well as in both central and surrounding region. The number of apoptotic cells increased from 12h after injury, increased to the peak at 4d and declined to normal at 21d. Conclu sion The results suggest that apoptosis, especially glial apoptosis, plays a role in the pathogenesis of spinal cord in jury.

  4. Spinal cord injury and its association with blunt head trauma

    Directory of Open Access Journals (Sweden)

    Paiva WS

    2011-09-01

    Full Text Available Wellingson S Paiva, Arthur MP Oliveira, Almir F Andrade, Robson LO Amorim, Leonardo JO Lourenço, Manoel J TeixeiraDivision of Neurosurgery, University of São Paulo, BrazilBackground: Severe and moderate head injury can cause misdiagnosis of a spinal cord injury, leading to devastating long-term consequences. The objective of this study is to identify risk factors involving spine trauma and moderate-to-severe brain injury.Methods: A prospective study involving 1617 patients admitted in the emergency unit was carried out. Of these patients, 180 with moderate or severe head injury were enrolled. All patients were submitted to three-view spine series X-ray and thin cut axial CT scans for spine trauma investigations.Results: 112 male patients and 78 female patients, whose ages ranged from 11 to 76 years (mean age, 34 years. The most common causes of brain trauma were pedestrians struck by motor vehicles (31.1%, car crashes (27.7%, and falls (25%. Systemic lesions were present in 80 (44.4% patients and the most common were fractures, and lung and spleen injuries. 52.8% had severe and 47.2% moderate head trauma. Fourteen patients (7.8% suffered spinal cord injury (12 in cervical spine, one in lumbar, and one thoracic spine. In elderly patients, the presence of associated lesions and Glasgow Coma Scale (GCS < 9 were statistically significant as risk factors (P < 0.05 for spine injury.Conclusion: Spinal cord injury related to moderate and severe brain trauma usually affects the cervical spine. The incidence of spinal lesions and GCS < 9 points were related to greater incidence of spinal cord injury.Keywords: head injury, spine trauma, risk factors

  5. Relationship of psychology inpatient rehabilitation services and patient characteristics to outcomes following spinal cord injury: the SCIRehab project.

    Science.gov (United States)

    Heinemann, Allen W; Wilson, Catherine S; Huston, Toby; Koval, Jill; Gordon, Samuel; Gassaway, Julie; Kreider, Scott E D; Whiteneck, Gale

    2012-11-01

    To evaluate the effects of psychological interventions on rehabilitation outcomes, including residence and functional status at discharge, and residence, school attendance, or employment, and physical, social, occupational, and mobility aspects of participation 1 year after spinal cord injury (SCI). Prospective observational cohort study. Six inpatient rehabilitation facilities in the United States. Inpatients with SCI 12 years of age and older. Usual rehabilitation care. Functional Independence Measure at rehabilitation discharge and 1-year injury anniversary; discharge destination and residence at 1-year anniversary; Craig Handicap Assessment and Reporting Technique, Diener Satisfaction with Life Scale, Patient Health Questionnaire, employment or school attendance, rehospitalization, and occurrence of a pressure ulcer at 1-year anniversary. More time in psycho-educational interventions was associated with better function, discharge to home, home residence at 1 year, and the absence of pressure ulcers at 1 year. More psychotherapeutic sessions focusing on processing emotions and/or locus of control were associated with poorer function at discharge and 1 year, less physical independence and community mobility, lower satisfaction with life, and the presence of pressure sores at 1 year. Psychological services are an important component of comprehensive medical rehabilitation and tailored to patient needs and readiness to benefit from rehabilitation. Services focused on remediating deficits tend to be associated with negative outcomes, while services intended to foster adjustment and growth tend to be associated with favorable outcomes. Further research is needed to determine the optimal type and timing of psychological services during inpatient rehabilitation based on individuals' strengths and vulnerabilities. Note: This is the sixth in this third series of SCIRehab articles.

  6. Clinical Trial of Human Fetal Brain-Derived Neural Stem/Progenitor Cell Transplantation in Patients with Traumatic Cervical Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Ji Cheol Shin

    2015-01-01

    Full Text Available In a phase I/IIa open-label and nonrandomized controlled clinical trial, we sought to assess the safety and neurological effects of human neural stem/progenitor cells (hNSPCs transplanted into the injured cord after traumatic cervical spinal cord injury (SCI. Of 19 treated subjects, 17 were sensorimotor complete and 2 were motor complete and sensory incomplete. hNSPCs derived from the fetal telencephalon were grown as neurospheres and transplanted into the cord. In the control group, who did not receive cell implantation but were otherwise closely matched with the transplantation group, 15 patients with traumatic cervical SCI were included. At 1 year after cell transplantation, there was no evidence of cord damage, syrinx or tumor formation, neurological deterioration, and exacerbating neuropathic pain or spasticity. The American Spinal Injury Association Impairment Scale (AIS grade improved in 5 of 19 transplanted patients, 2 (A → C, 1 (A → B, and 2 (B → D, whereas only one patient in the control group showed improvement (A → B. Improvements included increased motor scores, recovery of motor levels, and responses to electrophysiological studies in the transplantation group. Therefore, the transplantation of hNSPCs into cervical SCI is safe and well-tolerated and is of modest neurological benefit up to 1 year after transplants. This trial is registered with Clinical Research Information Service (CRIS, Registration Number: KCT0000879.

  7. Effects of paraplegia on quality of life and family economy among patients with spinal cord injuries in selected hospitals of Sri Lanka.

    Science.gov (United States)

    Kalyani, H H N; Dassanayake, S; Senarath, U

    2015-06-01

    The study was conducted with the aim of assessing the effects of paraplegia caused by spinal cord injuries on the quality of life of patients and their family economy. A descriptive cross-sectional study. The study was carried out in Accident Service, Orthopedic and Neurosurgery Units of the National Hospital of Sri Lanka and the Spinal Injury Unit of Rehabilitation Hospital Ragama. One hundred traumatic paraplegic patients were included as the study sample. Modified Ferrans and Powers quality of life index: spinal cord injury version was used to measure the quality of life. Pre- and post-family economic data were collected using an interviewer-administered questionnaire. Quality of Life was calculated under four major components. Paraplegics' family component (mean=3.50) and social, economic aspects (mean=3.24) are considerably good when compared with health and functioning (mean=2.83) and psychological (mean=2.78) components. Also the study revealed that expenditures are significantly high (P=0.001) and income is significantly less (P=0.001) after injury than before. Quality of life is relatively good on family and social aspects, whereas the physical and psychological aspects are somewhat poor. Regarding family economy, expenses are significantly high and earnings are significantly less after the injury. Contribution to the income from self-employment shows the most significant decline. Findings suggest that the family economy of such patients should be supported.

  8. Comparison between dopaminergic agents and physical exercise as treatment for periodic limb movements in patients with spinal cord injury.

    Science.gov (United States)

    De Mello, M T; Esteves, A M; Tufik, S

    2004-04-01

    Randomized controlled trial of physical exercise and dopaminergic agonist in persons with spinal cord injury and periodic leg movement (PLM). The objective of the present study was to compare the effectiveness of physical exercise and of a dopaminergic agonist in reducing the frequency of PLM. Centro de Estudos em Psicobiologia e Exercício. Universidade Federal de São Paulo, Brazil. A total of 13 volunteers (mean age: 31.6+/-8.3 years) received L-DOPA (200 mg) and benserazide (50 mg) 1 h before sleeping time for 30 days and were then submitted to a physical exercise program on a manual bicycle ergometer for 45 days (3 times a week). Both L-DOPA administration (35.11-19.87 PLM/h, P<0.03) and physical exercise (35.11-18.53 PLM/h, P<0.012) significantly reduced PLM; however, no significant difference was observed between the two types of treatment. The two types of treatment were found to be effective in the reduction of PLM; however, physical exercise is indicated as the first treatment approach, while dopaminergic agonists or other drugs should only be recommended for patients who do not respond to this type of treatment.

  9. Acute effect of electrical stimulation of the dorsal genital nerve on rectal capacity in patients with spinal cord injury.

    Science.gov (United States)

    Worsøe, J; Fynne, L; Laurberg, S; Krogh, K; Rijkhoff, N J M

    2012-06-01

    Constipation and fecal incontinence are considerable problems for most individuals with spinal cord injury (SCI). Neurogenic bowel symptoms are caused by several factors including abnormal rectal wall properties. Stimulation of the dorsal genital nerve (DGN) can inhibit bladder contractions and because of common innervation inhibitory effects are anticipated in the rectum too. Therefore, DNG could have a future role in the treatment of neurogenic fecal incontinence. To study the effect of acute DGN stimulation on the rectal cross sectional area (CSA) in SCI patients. Seven patients with complete supraconal SCI (median age 50 years) were included. Stimulation was applied via plaster-electrodes using an amplitude of twice the genito-anal reflex threshold (pulse width: 200 μs; pulse rate: 20 Hz). A pressure controlled phasic (10, 20 and 30 cmH(2)O) rectal distension protocol was repeated four times with subjects randomized to stimulation during 1st and 3rd distension series or 2nd and 4th distension series. The rectal CSA and pressure were measured using impedance planimetry and manometry. All patients completed the investigation. Median stimulation amplitude was 51 mA (range 30-64). CSA was smaller during stimulation and differences reached statistical significance at distension pressures of 20 cmH(2)O (average decrease 9%; P = 0.02) and 30 cmH(2)O (average decrease 4%; P = 0.03) above resting rectal pressure. Accordingly, rectal pressure-CSA relation was significantly reduced during stimulation at 20 (P=0.03) and 30 cmH(2)O distension (P=0.02). DGN Stimulation in patients with supraconal SCI results in an acute decrease of rectal CSA and the rectal pressure-CSA relation.

  10. Nanomedicine strategies for treatment of secondary spinal cord injury

    Directory of Open Access Journals (Sweden)

    White-Schenk D

    2015-01-01

    Full Text Available Désirée White-Schenk,1,4 Riyi Shi,1–3 James F Leary1–4 1Interdisciplinary Biomedical Sciences Program, 2Weldon School of Biomedical Engineering, 3Department of Basic Medical Sciences, Lynn School of Veterinary Medicine, 4Birck Nanotechnology Center, Discovery Park, Purdue University, West Lafayette, IN, USA Abstract: Neurological injury, such as spinal cord injury, has a secondary injury associated with it. The secondary injury results from the biological cascade after the primary injury and affects previous uninjured, healthy tissue. Therefore, the mitigation of such a cascade would benefit patients suffering a primary injury and allow the body to recover more quickly. Unfortunately, the delivery of effective therapeutics is quite limited. Due to the inefficient delivery of therapeutic drugs, nanoparticles have become a major field of exploration for medical applications. Based on their material properties, they can help treat disease by delivering drugs to specific tissues, enhancing detection methods, or a mixture of both. Incorporating nanomedicine into the treatment of neuronal injury and disease would likely push nanomedicine into a new light. This review highlights the various pathological issues involved in secondary spinal cord injury, current treatment options, and the improvements that could be made using a nanomedical approach. Keywords: spinal cord injury, acrolein, drug delivery, methylprednisolone, secondary injury

  11. Does surgical treatment within 4 hours after trauma have an influence on neurological remission in patients with acute spinal cord injury?

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    Biglari B

    2016-08-01

    Full Text Available Bahram Biglari,1 Christopher Child,2 Timur Mert Yildirim,2 Tyler Swing,2 Tim Reitzel,1 Arash Moghaddam2 1Department of Paraplegiology and Technical Orthopedics, BG Trauma Centre, Ludwigshafen, Germany; 2Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord injury, Heidelberg University Hospital, Heidelberg, Germany Background: The proper timing for surgery in patients with acute spinal cord injury is controversial. This study was conducted to detect if there is an advantage in early (within the first 4 hours after trauma compared to late (between 4 and 24 hours after trauma surgery on neurological outcome.Methods: In this single institution prospective cohort study, data were analyzed from 51 spinal cord injured patients with an average age of 43.4 (±19.2 years. The influence of early (29 patients within the first 4 hours as opposed to late (22 patients between 4 and 24 hours decompression was evaluated by comparing data for neurological outcome. Patients of the study collectively suffered acute spinal fractures from C2 to L3 (cervical 39.2%, thoracic 29.4%, and lumbal 21.6% or nonosseous lesions (9.8%. American Spinal Injury Association (ASIA Impairment Scale (AIS grades were assessed at time of admission and 6 months after trauma or longer depending on the time of release. Surgical treatment included early stabilization and decompression within 24 hours.Results: No significant difference between improved neurological function, measured with the AIS, and an early or late surgery time can be seen (P=0.402. Furthermore, binary logistic regression shows no significant difference between sex or age, and AIS improvement as possible confounders.Conclusion: In our study, all patients with spinal cord injury were treated with spine stabilization and decompression within the first 24 hours after trauma. Surgical decompression within the first 4 hours after trauma was not associated with improved neurological outcome

  12. Olfactory ensheathing cell transplantation in 106 patients with old spinal cord injury Differences in ages, sexes, disease courses, injured types and sites

    Institute of Scientific and Technical Information of China (English)

    Zuncheng Zheng; Chao Liu; Lin Zhang; Rui Gao; Shugang Wei; Kun Zhang; Lei Zhang

    2007-01-01

    BACKGROUND: It has been demonstrated that the transplantation of olfactory ensheathing cell (OEC) can promote the recovery of neurological function through ameliorating the local internal environment in spinal cord injury.OBJECTIVE: To evaluate the recent efficacy of OEC transplantation on old spinal cord injury. DESIGN: A self-controlled experiment.SETTING: Department of Neurosurgery, Taian Rongjun Hospital of Shandong Province. PARTICIPANTS: Totally 106 inpatients with old spinal cord injury were selected from the Department of Neurosurgery, Taian Rongjun Hospital of Shandong Province from June 2004 to December 2006, including 97 males and 9 females. Inclusive criteria:①Complete data;②Informed with the fact;③No further recover neurological function after drug therapy (neurotrophic factor, GM-1), traditional Chinese medicine, physiotherapy and rehabilitative exercises;④No obvious compression of the injured spinal cord displayed by MRI examination.METHODS:①The olfactory bulb was obtained from embryo of induced labor in middle pregnancy above 4 months supplied voluntarily by pregnant women, and the survived cells after purification and culture for 1-2 weeks were collected. Dura mater was incised by posterior approach, then the cultured OEC suspension was transplanted to corresponding regions by means of multi-target injection using microscope.②The patients were evaluated for twice with the standards suggested by American Spinal Injury Association (ASIA) at admission and 2-4 weeks postoperatively, in order to investigate the efficacy in different age groups, different sites and at different time points after the OEC transplantation.③Standards for evaluation: The International Standard for Neurological and Functional Classification of Spinal Cord Injury set by ASIA: The highest score of motor function was 100 points; The highest score of sensory function was 112 points for light touch and 112 for acupuncture sense. Frankel grading modified by ASIA in

  13. Letter to the editor regarding "Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis"

    Directory of Open Access Journals (Sweden)

    Dijkers MP

    2016-11-01

    Full Text Available Marcel P Dijkers,1 Katherine G Akers,2 Sujay S Galen,3 Diane E Patzer,4 Phuong T Vu41Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, 2Shiffman Medical Library, Wayne State University, Detroit, 3Physical Therapy Program, Wayne State University, Detroit, 4Center for Spinal Cord Injury Recovery, Rehabilitation Institute of Michigan, Detroit, MI, USAIn the article “Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis”, published in the March issue of Medical Devices: Evidence and Research, Miller et al1 present a meta-analysis of the clinical effectiveness and safety of powered exoskeletons for spinal cord injury (SCI patients. A close examination of this article shows surprising coincidences, in that two primary studies (references 25 and 33 in the reference list report the same proportions and 95% confidence intervals (CIs of subjects able to ambulate with an exoskeleton without assistance (Figure 2 of the study, and two different primary studies (references 26 and 28 report the same mean and 95% CIs for the distance (in meters walked in a 6-minute walk test (Figure 4 of the study.View the original paper by Miller and colleagues.

  14. Bone turnover markers and parameters of functional and structural state in patients with chronic spinal cord injuries in 5 years and later after the trauma

    Directory of Open Access Journals (Sweden)

    M.A. Bystrytska

    2017-08-01

    Full Text Available Background. The increased life expectancy of persons with complete spinal cord injury brings into focus the late complications of spinal cord injuries (SCI including osteoporosis. Purpose of the study was to evaluate the bone mineral status and bone turnover markers in patients with chronic spinal cord injury of 5 years and over. Materials and methods. Seventy-three subjects who suffered from complete spinal cord injury with tetra- or paraplegia and 57 healthy persons were examined. Bone status was determined by ultrasound (US densitometry of the calcaneal bone using quantitative ultrasonometer Sahara (Hologic Inc., model 04874, 2008. Bone turnover markers in the peripheral blood (osteocalcin, procollagen type 1 propeptide (P1NP, collagen type 1 cross-linked C-telopeptide (β-CTx and vitamin D were defined by electrochemiluminescence method. Results. SCI patients demonstrated significantly lower parameters of bone mineral status compared with the subjects of the control group. The stiffness index (SI was 51.4 ± 11.8 % vs. 98.5 ± 16.6 % (p < 0.05 in men and 50.1 ± 9.8 % vs. 92 9 ± 11.1 % (p < 0.05 in women. There was significant reduction of bone mass index in SCI patients and in the individuals of the control group after 2 years, but bone loss over time was significantly worse in SCI patients (–16.5 ± 2.4 % vs. –2.5 ± 0.9 %, respectively; p < 0.05. In SCI patients levels of bone turnover markers were significantly higher than the relative values in Ukrainian population. Conclusions. SCI with complete spinal cord injury leads to increased bone resorption with formation of secondary osteoporosis (according to the data of ultrasound densitometry of the calcaneal bone. In the late posttraumatic period bone destruction processes are slowing down but remain higher than in the population as a whole, combined with low levels of vitamin D and absence of axial load results in continued loss of trabecular bone mass.

  15. Vascular dysfunctions following spinal cord injury.

    Science.gov (United States)

    Popa, Constantin; Popa, Florian; Grigorean, Valentin Titus; Onose, Gelu; Sandu, Aurelia Mihaela; Popescu, Mihai; Burnei, Gheorghe; Strambu, Victor; Sinescu, Crina

    2010-01-01

    The aim of this article is to analyze the vascular dysfunctions occurring after spinal cord injury (SCI). Vascular dysfunctions are common complications of SCI. Cardiovascular disturbances are the leading causes of morbidity and mortality in both acute and chronic stages of SCI. Neuroanatomy and physiology of autonomic nervous system, sympathetic and parasympathetic, is reviewed. SCI implies disruption of descendent pathways from central centers to spinal sympathetic neurons, originating in intermediolateral nuclei of T1-L2 cord segments. Loss of supraspinal control over sympathetic nervous system results in reduced overall sympathetic activity below the level of injury and unopposed parasympathetic outflow through intact vagal nerve. SCI associates significant vascular dysfunction. Spinal shock occurs during the acute phase following SCI and it is a transitory suspension of function and reflexes below the level of the injury. Neurogenic shock, part of spinal shock, consists of severe arterial hypotension and bradycardia. Autonomic dysreflexia appears during the chronic phase, after spinal shock resolution, and it is a life-threatening syndrome of massive imbalanced reflex sympathetic discharge occurring in patients with SCI above the splanchnic sympathetic outflow (T5-T6). Arterial hypotension with orthostatic hypotension occurs in both acute and chronic phases. The etiology is multifactorial. We described a few factors influencing the orthostatic hypotension occurrence in SCI: sympathetic nervous system dysfunction, low plasma catecholamine levels, rennin-angiotensin-aldosterone activity, peripheral alpha-adrenoceptor hyperresponsiveness, impaired function of baroreceptors, hyponatremia and low plasmatic volume, cardiovascular deconditioning, morphologic changes in sympathetic neurons, plasticity within spinal circuits, and motor deficit leading to loss of skeletal muscle pumping activity. Additional associated cardiovascular concerns in SCI, such as deep vein

  16. An integrated gait rehabilitation training based on Functional Electrical Stimulation cycling and overground robotic exoskeleton in complete spinal cord injury patients: Preliminary results.

    Science.gov (United States)

    Mazzoleni, S; Battini, E; Rustici, A; Stampacchia, G

    2017-07-01

    The aim of this study is to investigate the effects of an integrated gait rehabilitation training based on Functional Electrical Stimulation (FES)-cycling and overground robotic exoskeleton in a group of seven complete spinal cord injury patients on spasticity and patient-robot interaction. They underwent a robot-assisted rehabilitation training based on two phases: n=20 sessions of FES-cycling followed by n= 20 sessions of robot-assisted gait training based on an overground robotic exoskeleton. The following clinical outcome measures were used: Modified Ashworth Scale (MAS), Numerical Rating Scale (NRS) on spasticity, Penn Spasm Frequency Scale (PSFS), Spinal Cord Independence Measure Scale (SCIM), NRS on pain and International Spinal Cord Injury Pain Data Set (ISCI). Clinical outcome measures were assessed before (T0) after (T1) the FES-cycling training and after (T2) the powered overground gait training. The ability to walk when using exoskeleton was assessed by means of 10 Meter Walk Test (10MWT), 6 Minute Walk Test (6MWT), Timed Up and Go test (TUG), standing time, walking time and number of steps. Statistically significant changes were found on the MAS score, NRS-spasticity, 6MWT, TUG, standing time and number of steps. The preliminary results of this study show that an integrated gait rehabilitation training based on FES-cycling and overground robotic exoskeleton in complete SCI patients can provide a significant reduction of spasticity and improvements in terms of patient-robot interaction.

  17. Lifestyle and health conditions of adults with spinal cord injury

    Directory of Open Access Journals (Sweden)

    Inacia Sátiro Xavier de França

    2014-07-01

    Full Text Available Objective. To describe the lifestyle of adults with spinal cord injury and explore its relation with some health conditions. Methodology. Cross sectional study, in which a questionnaire containing sociodemographic, habits and health conditions variables was used. Forty-seven people with spinal cord injury participated and answered the self-report questionnaire. Results. The group under study was predominantly male (92%, under 40 years of age (47%, and had low educational level (76%. The most frequent risk factors related to the lifestyle were: smoking (28%, alcohol consumption (36%, coffee consumption (92% and being physically inactive (64%. Association was found between having four or more risk factors related to lifestyle and the loss of appetite, as well as constipation. Conclusion. The actual inadequate lifestyle is associated with the health conditions of patients, and the nursing team should pay special attention to the education and promotion of health related to people with spinal cord injury.

  18. A Comparative Study of Ultrasound Examination of Urinary Tract Performed on Spinal Cord Injury Patients with No Urinary Symptoms and Spinal Cord Injury Patients with Symptoms Related to Urinary Tract: Do Findings of Ultrasound Examination Lead to Changes in Clinical Management?

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2006-01-01

    Full Text Available Findings of ultrasound examination of the urinary tract and changes in clinical management, which were instituted on the basis of ultrasound examination, were compared between two groups of spinal cord injury patients. Group 1 had no urinary symptoms when they underwent the scan, whereas group 2 was comprised of patients with symptoms pertaining to the urinary tract. Between 2000 and 2006, ultrasound examination of the urinary tract was performed in 87 spinal cord injury patients who had no urinary symptoms when they underwent the ultrasound scan. No abnormality was found in 63 patients. The ultrasound scan showed some abnormality of the urinary tract in 24 patients (simple cyst in the kidney: 4; reduced size of a kidney: 3; increased echogenicity of left kidney: 1; prominent extrarenal pelvis and mild calyceal dilatation: 1; slightly dilated renal pelvis and calyceal system: 1; pelvic kidney showing mild hydronephrosis: 1; foetal lobulation of kidney: 2; multicystic kidney with no interval change in the appearance since last examination: 1; 2-cm-diameter parapelvic cyst: 1; small renal calyceal calculus: 5; a little cortical scarring bilaterally: 1; focal renal scar: 2; generalised thinning of renal cortex: 3; increase in renal sinus fat: 3; trabeculated bladder: 2; small vesical diverticulum: 1; mild generalised bladder wall thickening: 1; small residual urine in postvoid scan; 2. No specific interventions were performed in these patients on the basis of ultrasound findings. In Group 2, ultrasound examination revealed serious abnormalities such as hydronephrosis, pyonephrosis, vesical calculi, vesical polyp in 20 of 21 patients, and all 20 patients required therapeutic intervention on the basis of ultrasound scan findings.In conclusion, routine ultrasound examination of the urinary tract in spinal cord injury patients who have no urinary symptoms may not be justifiable in terms of cost effectiveness; limited hospital resources should be

  19. Cell therapy for spinal cord injury informed by electromagnetic waves.

    Science.gov (United States)

    Finnegan, Jack; Ye, Hui

    2016-10-01

    Spinal cord injury devastates the CNS, besetting patients with symptoms including but not limited to: paralysis, autonomic nervous dysfunction, pain disorders and depression. Despite the identification of several molecular and genetic factors, a reliable regenerative therapy has yet to be produced for this terminal disease. Perhaps the missing piece of this puzzle will be discovered within endogenous electrotactic cellular behaviors. Neurons and stem cells both show mediated responses (growth rate, migration, differentiation) to electromagnetic waves, including direct current electric fields. This review analyzes the pathophysiology of spinal cord injury, the rationale for regenerative cell therapy and the evidence for directing cell therapy via electromagnetic waves shown by in vitro experiments.

  20. Hydronephrosis and renal failure following inadequate management of neuropathic bladder in a patient with spinal cord injury: Case report of a preventable complication

    Directory of Open Access Journals (Sweden)

    Vaidyanathan Subramanian

    2012-09-01

    Full Text Available Abstract Background Condom catheters are indicated in spinal cord injury patients in whom intravesical pressures during storage and voiding are safe. Unmonitored use of penile sheath drainage can lead to serious complications. Case report A 32-year old, male person, sustained complete paraplegia at T-11 level in 1985. He had been using condom catheter. Eleven years after sustaining spinal injury, intravenous urography showed no radio-opaque calculus, normal appearances of kidneys, ureters and bladder. Blood urea and Creatinine were within reference range. A year later, urodynamics revealed detrusor pressure of 100 cm water when detrusor contraction was initiated by suprapubic tapping. This patient was advised intermittent catheterisation and take anti-cholinergic drug orally; but, he wished to continue penile sheath drainage. Nine years later, this patient developed bilateral hydronephrosis and renal failure. Indwelling urethral catheter drainage was established. Five months later, ultrasound examination of urinary tract revealed normal kidneys with no evidence of hydronephrosis. Conclusion Spinal cord injury patients with high intravesical pressure should not have penile sheath drainage as these patients are at risk for developing hydronephrosis and renal failure. Intermittent catheterisation along with antimuscarinic drug should be the preferred option for managing neuropathic bladder.

  1. Critical care of traumatic spinal cord injury.

    Science.gov (United States)

    Jia, Xiaofeng; Kowalski, Robert G; Sciubba, Daniel M; Geocadin, Romergryko G

    2013-01-01

    Approximately 11 000 people suffer traumatic spinal cord injury (TSCI) in the United States, each year. TSCI incidences vary from 13.1 to 52.2 per million people and the mortality rates ranged from 3.1 to 17.5 per million people. This review examines the critical care of TSCI. The discussion will focus on primary and secondary mechanisms of injury, spine stabilization and immobilization, surgery, intensive care management, airway and respiratory management, cardiovascular complication management, venous thromboembolism, nutrition and glucose control, infection management, pressure ulcers and early rehabilitation, pharmacologic cord protection, and evolving treatment options including the use of pluripotent stem cells and hypothermia.

  2. Glial implications in transplantation therapy of spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    CHEN Shi-wen; XIE Yu-feng

    2009-01-01

    Spinal cord injuries are damages that result in complete or partial loss of sensation and/or mobility and affect the life qualities of many patients. Their pathophysiology in-cludes primary and secondary processes, which are related with the activation of astrocytes and microgliacytes and the degeneration of oligodendrocytes. Although transplan-tation of embryonic stem cells or neural progenitor cells is an attractive strategy for repair of the injured central ner-vous system (CNS), transplantation of these cells alone for acute spinal cord injuries has not resulted in robust axon regeneration beyond the injury sites. This may be due to the progenitor cells differentiating to the cell types that sup-port axon growth poorly and/or their inability to modify the inhibitory environment of adult CNS after injury. Recent studies indicate that transplantation of glial progenitor cells has exhibited beneficial effects on the recovery and promis-ing future for the therapy strategy of spinal cord injury. In this review, we summarized the data from recent literature regarding glial implications in transplantation therapy of spinal cord injury.

  3. [Traumatic spinal cord injury in people over 65 in Asturias].

    Science.gov (United States)

    Álvarez Pérez, María José; López Llano, María Luisa

    to assess incidence, causes and socio-demographicaspects of traumatic spinal cord injury among patients over 65 in Asturias (Spain). A census was performed between 1951 and 2013 of patients in Asturias, over 65 years-old coded as «traumatic spinal cord injury with or without vertebral fracture». Socio-demographic, hospital and clinical variables were recorded. In total 180 patients were registered, most of them males (60%), with a mean age of 73 years (maximum 91). The estimated incidence in 2010 was found to be 24.9, in 2011, 28.9 and in 2012, 32.9 cases/million/year. The distribution in the type of injury was homogeneous and location in the cervical spine (40%) was found to be more common. There was bone injury in 71.4%, with multilevel injury in more than half of the cases. The main cause was accidental fall (52.1%), mainly at own height (68.6%), and most of them located in the cervical spine (38.5%), followed by traffic accidents with 57.6% located in the cervical spine. A change was observed in the epidemiological profile of the patients over 65 years old with spinal cord injury. There were more cases associated with accidental fall. It is necessary to create specific preventive and therapeutic strategies for this group. Copyright © 2015 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Spinal cord injuries in older children: is there a role for high-dose methylprednisolone?

    Science.gov (United States)

    Arora, Bhawana; Suresh, Srinivasan

    2011-12-01

    We present a retrospective case series of 15 children (aged 8-16 years) with blunt traumatic spinal cord injury who were treated with methylprednisolone as per the National Acute Spinal Cord Injury Study protocol. Of all patients, 12 (80%) were male. Causes were sports injuries (n = 9), motor vehicle crashes (n = 2), and falls (n = 4). Most injuries were nonskeletal (n = 14), and all patients had incomplete injury of the spinal cord. The most common location of tenderness was cervical (n = 7). Of the 15 patients, methylprednisolone was initiated within 3 hours in 13 patients and between 3 and 8 hours in 2 patients. All patients received the medication for 23 hours as per the National Acute Spinal Cord Injury Study protocol. Of the 15 patients, 13 recovered completely by 24 hours and were discharged with a diagnosis of spinal cord concussion. One patient had compression fracture of T5 and T3-T5 spinal contusion but no long-term neurological deficit. One patient was discharged with diagnosis of C1-C3 spinal cord contusion (by magnetic resonance imaging) and had partial recovery at 2 years after injury. All patients with a diagnosis of cord concussion had normal plain films of the spine and computed tomographic and magnetic resonance imaging findings. None of the patients had any associated major traumatic injuries to other organ systems. The high-dose steroid therapy did not result in any serious bacterial infections.

  5. Vocational reintegration following spinal cord injury : expectations, participation and interventions

    NARCIS (Netherlands)

    Schönherr, M.C.; Groothoff, J.W.; Mulder, G.A.; Schoppen, T.; Eisma, W.H.

    2004-01-01

    Study design: Survey. Objectives: To explore the process of reintegration in paid work following a traumatic spinal cord injury (SCI), including the role of early expectations of individual patients regarding return to work, indicators of success of job reintegration and a description of reintegrati

  6. The effect of Sativex in neuropathic pain and spasticity in spinal cord injury

    DEFF Research Database (Denmark)

    Andresen, Sven Robert; Hansen, Rikke Bod Middelhede; Johansen, Inger Lauge

    2014-01-01

    Introduction: Neuropathic pain and spasticity after spinal cord injury represent significant but still unresolved problems, which cause considerable suffering and reduced quality of life for patients with spinal cord injury. Treatment of neuropathic pain and spasticity is complicated and patients...... injury. Aims: To investigate the effect of Sativex (cannabinoid agonist given as an oral mucosal spray), on neuropathic pain and spasticity in patients with spinal cord injury. Methods: A randomized, double-blind, placebo-controlled crossover study. We will include 30 patients with neuropathic pain...

  7. The treatment of neurogenic dysfunction of bladder and bowel in patient with spinal cord injury

    OpenAIRE

    Babović Rade; Milićević Saša

    2011-01-01

    Neurogenic dysfunction of bladder and bowel, caused as a result of spinal nerve structures lesion, present a major problem for the patient, his environment and health care workers. Proper diagnosis of neurogenic dysfunction of bladder and bowel allows the application of an appropriate treatment plan that will allow adequate emptying and prevention of complications that may endanger the patient's life. Adequate treatment provides a uniform approach to this important issue in rehabilitation and...

  8. Cine phase-contrast MRI measurement of CSF flow in the cervical spine: a pilot study in patients with spinal cord injury

    Science.gov (United States)

    Negahdar, MJ; Shakeri, M.; McDowell, E.; Wells, J.; Vitaz, T.; Harkema, S.; Amini, A.

    2011-03-01

    MRI velocimetry (also known as phase-contrast MRI) is a powerful tool for quantification of cerebrospinal fluid (CSF) flow in various regions of the brain and craniospinal junction and has been accepted as a diagnostic tool to assist with the diagnosis of certain conditions such as hydrocephalus and chiari malformations. Cerebrospinal fluid is continually produced in the ventricles of the brain, flows through the ventricular system and then out and around the brain and spinal cord and is reabsorbed over the convexity of the brain. Any disease process which either impedes the normal pattern of flow or restricts the area where flow occurs can change the pattern of these waveforms with the direction and velocity of flow being determined by the pressure transmitted from the pulsation of the heart and circulation of blood within the central nervous system. Therefore, we hypothesized that phase-contrast MRI could eventually be used as a diagnostic aid in determining the degree of spinal cord compression following injury to the cervical or thoracic spine. In this study, we examined CSF flow in 3 normal subjects and 2 subjects with non-acute injuries in the cervical spine using Cine phasecontrast MRI. CSF flow analysis was performed using an in-house developed software. The flow waveform was calculated in both normal subjects (n=3) as well as subjects with spinal cord injury in the cervical spine (n=2). The bulk flow at C2 was measured to be 0.30 +/- 0.05 cc, at 5 cm distal to C2, it was 0.19+/- 0.07 cc, and at 10 cm distal to C2, it was 0.17+/- 0.05 cc. These results were in good agreement with previously published results. In patients with spinal cord injury, at the site of injury in the cervical spine, bulk flow was found to be 0.08 +/- 0.12 cc, at 5 cm proximal to the site of injury it was found to be 0.18 +/- 0.07 cc, and at 5 cm distal to the site of injury, it was found to be 0.12 +/- 0.01 cc.

  9. Treating Chronic Pain after Spinal Cord Injury

    Science.gov (United States)

    2016-09-01

    5   Our preliminary data indicated that severe SCI rats exhibited cold allodynia. During this cycle we confirmed and expanded our studies. We...reflecting expanded nociceptive inputs to dorsal horn neurons [17; 20; 54]. However, in contrast to SCI of moderate severity, we did not observe changes in...traumatic injuries, including spinal cord injury ( SCI ). Chronic pain so greatly affects quality of life that depression and suicide frequently result

  10. Spinal cord injury patients with bladder function reconstruction nursing research%脊髓损伤患者重建膀胱功能护理研究

    Institute of Scientific and Technical Information of China (English)

    巨宝兰; 杨艳平; 许丽英

    2012-01-01

    Objective Spinal cord injury patients during hospitalization the implementation of reconstruction of bladder function training, improve the ability of daily life of patients with paraplegia. Methods 63 cases of paraplegia patients in our department stages, combined application of sterile intermittent catheterization, bladder veins shortwave and acupuncture treatment for patients with bladder function reconstruction, training. Results 63 cases of patients with paraplegia in a positive mood with treatment, were recovered within 4 weeks of autonomous urination. Conclusion The reconstruction of bladder function training on the recovery of patients with spinal cord injury positive effect, it is worthy of clinical application.%目的:对脊髓损伤患者在位院期间实施重建膀胱功能训练,提高截瘫患者生活自理能力.方法:对我科6 3例截瘫患者分阶段,联合应用无菌间歇导尿、膀胱区脉短波及针灸治疗,为患者训练膀胱功能重建.结果:63例截瘫患者以积极乐观的情绪配合治疗,均在4周内恢复自主排尿.结论:重建膀胱功能训练对脊髓损伤患者的康复的积极作用,值得临床推广应用.

  11. Work-rate-guided exercise testing in patients with incomplete spinal cord injury using a robotics-assisted tilt-table.

    Science.gov (United States)

    Laubacher, Marco; Perret, Claudio; Hunt, Kenneth J

    2015-01-01

    Robotics-assisted tilt-table (RTT) technology allows neurological rehabilitation therapy to be started early thus alleviating some secondary complications of prolonged bed rest. This study assessed the feasibility of a novel work-rate-guided RTT approach for cardiopulmonary training and assessment in patients with incomplete spinal cord injury (iSCI). Three representative subjects with iSCI at three distinct stages of primary rehabilitation completed an incremental exercise test (IET) and a constant load test (CLT) on a RTT augmented with integrated leg-force and position measurement and visual work rate feedback. Feasibility assessment focused on: (i) implementation, (ii) limited efficacy testing, (iii) acceptability. (i) All subjects were able follow the work rate target profile by adapting their volitional leg effort. (ii) During the IETs, peak oxygen uptake above rest was 304, 467 and 1378 ml/min and peak heart rate (HR) was 46, 32 and 65 beats/min above rest (subjects A, B and C, respectively). During the CLTs, steady-state oxygen uptake increased by 42%, 38% and 162% and HR by 12%, 20% and 29%. (iii) All exercise tests were tolerated well. The novel work-rate guided RTT intervention is deemed feasible for cardiopulmonary training and assessment in patients with iSCI: substantial cardiopulmonary responses were observed and the approach was found to be tolerable and implementable. Implications for Rehabilitation Work-rate guided robotics-assisted tilt-table technology is deemed feasible for cardiopulmonary assessment and training in patients with incomplete spinal cord injury. Robotics-assisted tilt-tables might be a good way to start with an active rehabilitation as early as possible after a spinal cord injury. During training with robotics-assisted devices the active participation of the patients is crucial to strain the cardiopulmonary system and hence gain from the training.

  12. Vocational perspectives after spinal cord injury

    NARCIS (Netherlands)

    Schonherr, MC; Groothoff, JW; Mulder, GA; Eisma, WH; Schönherr, M.C.

    2005-01-01

    Objective: To give insight into the vocational situation several years after a traumatic spinal cord injury (SCI) and describe the personal experiences and unmet needs; to give an overview of health and functional status per type of SCI and their relationship with employment status. Design: Descript

  13. Relationship Between Depressive State and Treatment Characteristics of Acute Cervical Spinal Cord Injury in Japan

    OpenAIRE

    2016-01-01

    Background Few studies have assessed whether treatment of acute cervical spinal cord injury (SCI) patients contributes to depression. Methods Using an administrative database, we assessed patients for whom the diagnosis was unspecified injuries of cervical spinal cord (International Classification of Diseases and Injuries-10th (ICD-10) code; S14.1). We categorized patients with codes for depressive episode (ICD-10 code; F32) or recurrent depressive disorder (F33), or those prescribed antidepr...

  14. Elevated serum titers of proinflammatory cytokines and CNS autoantibodies in patients with chronic spinal cord injury.

    Science.gov (United States)

    Hayes, K C; Hull, T C L; Delaney, G A; Potter, P J; Sequeira, K A J; Campbell, K; Popovich, P G

    2002-06-01

    This study characterized the proinflammatory cytokines, interleukin-2 (IL-2) and tumor necrosis factor alpha (TNFalpha), the antiinflammatory cytokines, IL-4 and IL-10, autoantibodies specific for GM1 ganglioside (anti-GM1), IgG and IgM, and myelin-associated glycoprotein (anti-MAG), in the sera of infection-free, chronic (>12 months), traumatically injured SCI patients (n = 24). Healthy able-bodied subjects (n = 26) served as controls. The proinflammatory cytokines and anti-GM1 antibodies were of particular interest as they have been implicated in an autoimmune "channelopathy" component to central and peripheral conduction deficits in various chronic neuroinflammatory diseases. Antibody and cytokine titers were established using enzyme-linked immunosorbent assays (ELISA). The mean anti-GM(1) (IgM) titer value for the SCI group was significantly higher (p proinflammatory cytokines relative to control values. These results provide preliminary support for the hypothesis that chronic immunological activation in the periphery occurs in a subpopulation of chronic SCI patients. It remains to be established whether elevated serum titers of proinflammatory cytokines and autoantibodies against GM1 are beneficial to the patients or whether they are surrogate markers of a channelopathy that compounds the neurological impairment associated with traumatic axonopathy or myelinopathy.

  15. Rehabilitation outcome of upper extremity skilled performance in persons with cervical spinal cord injuries

    NARCIS (Netherlands)

    Spooren, Annemie I.F.; Janssen-Potten, Yvonne J.M.; Snoek, Govert J.; IJzerman, Maarten J.; Kerckhofs, Eric; Seelen, Henk A.M.

    2010-01-01

    Objective: To investigate changes in arm hand skilled performance during and after active rehabilitation in (sub)groups of subjects with cervical spinal cord injuries. Design: Longitudinal multi-centre cohort study. Patients: Persons with cervical spinal cord injuries during (n?=?57) and after (n?=

  16. Rehabilitation outcome of upper extremetiy skilled performance in persons with cervical spinal cord injuries

    NARCIS (Netherlands)

    Spooren, Annemie I.F.; Janssen-Potten, Yvonne J.M.; Snoek, Govert J.; IJzerman, Maarten Joost; Kerckhofs, Eric; Seelen, Henk A.M.

    2008-01-01

    Objective: To investigate changes in arm hand skilled performance during and after active rehabilitation in (sub)groups of subjects with cervical spinal cord injuries. Design: Longitudinal multi-centre cohort study. Patients: Persons with cervical spinal cord injuries during (n?=?57) and after (n?=?

  17. Abdominal pain in long-term spinal cord injury

    DEFF Research Database (Denmark)

    Finnerup, Nanna Brix; Faaborg, Pia Møller; Krogh, Klaus;

    2008-01-01

    /discomfort. There was no relation of abdominal pain to other types of pain.Conclusion:Chronic pain located in the abdomen is frequent in patients with long-term SCI. The delayed onset following SCI and the relation to constipation suggest that constipation plays an important role for this type of pain in the spinal cord injured.......Objectives:To describe the prevalence and character of chronic abdominal pain in a group of patients with long-term spinal cord injury (SCI) and to assess predictors of abdominal pain.Study design:Postal survey.Setting:Members of the Danish Paraplegic Association.Methods:We mailed a questionnaire...

  18. Reliability of cutaneous electrical perceptual threshold in the assessment of sensory perception in patients with spinal cord injury.

    Science.gov (United States)

    King, Nicolas K K; Savic, Gordana; Frankel, Hans; Jamous, Ali; Ellaway, Peter H

    2009-07-01

    The electrical perceptual threshold (EPT) test complements the American Spinal Injury Association (ASIA) assessment of cutaneous sensory function by providing a quantitative assessment for each dermatome. The aim here was to establish the reliability of the EPT by examining inter- and intra-rater repeatability of test results in spinal cord injury (SCI). Twelve persons with incomplete spinal cord injury (iSCI; two stable at >20 months and 10 sub-acute at sensory key points. A pulse of 0.5 ms in duration was applied three times per second. Threshold was determined by the method of limits. The strength of stimulation was augmented (0.1 mA.s(-1)) until the recipient reported sensation, then reduced until sensation was lost. EPT was taken as the lowest strength at which the subject reported sensation. Threshold was determined by two raters to establish intra- and inter-rater reliability. There were no significant differences in mean intra- or inter-rater EPT values at, above, or below the level of lesion (ASIA sensory level) for iSCI subjects. The intra-class correlation coefficient (ICC) was 0.56-0.80 for intra-rater and 0.52-0.91 for inter-rater classes, depending on the level tested. There was a significant correlation (Pearson's r = 0.93) between EPTs for four different dermatomes of control subjects assessed using two different types of stimulator. EPT provides an objective and quantitative measure of threshold for cutaneous sensory function. The method has good inter- and intra-rater reliability, and can be assessed using different stimulators.

  19. Effect of Alpha-1-Adrenergic Agonist, Midodrine for the Management of Long-Standing Neurogenic Shock in Patient with Cervical Spinal Cord Injury: A Case Report

    OpenAIRE

    Kim, Taikwan; Jwa, Cheol Su

    2015-01-01

    We report a rare case of a 71-year-old male patient who had suffered from long-lasting neurogenic shock for 13 weeks after cervical spinal cord injury (SCI) caused by a bicycle accident. The neurogenic shock was resolved dramatically 2 weeks after the administration of alpha-1-adrenergic agonist, midodrine hydrochloride. In usual cases, neurogenic shock tends to improve between 2 and 6 weeks after SCI; however, in a few cases, the shock lasts for several months. In our case, spinal shock last...

  20. Health service use in adults 20-64 years with traumatic brain injury, spinal cord injury or pelvic fracture. A cohort study with 9-year follow-up

    DEFF Research Database (Denmark)

    Laursen, Bjarne; Helweg-Larsen, Karin

    2012-01-01

    To estimate the health service use over 9 years after the injury year for patients with traumatic brain injury (TBI), spinal cord injury (SCI) and pelvic fracture (PF), and compare with non-injured.......To estimate the health service use over 9 years after the injury year for patients with traumatic brain injury (TBI), spinal cord injury (SCI) and pelvic fracture (PF), and compare with non-injured....

  1. Prediction of gait outcome with the knee-ankle-foot orthosis with medial hip joint in patients with spinal cord injuries: a study using recursive partitioning analysis.

    Science.gov (United States)

    Suzuki, T; Sonoda, S; Saitoh, E; Onogi, K; Fujino, H; Teranishi, T; Oyobe, T; Katoh, M; Ohtsuka, K

    2007-01-01

    Retrospective study of the degree of gait independence achieved by persons with spinal cord injury (SCI) using knee-ankle-foot orthosis with a medial single hip joint (MSH-KAFO). To examine the effects of the neurological level, degree of paresis, age, and inhibitory physical/other factors on the gait with a MSH-KAFO in patients with SCIs. Three university hospitals and two rehabilitation hospitals in Japan. The 45 patients (36 men, nine women) examined included 10 with injuries in the cervical cord between C6 and C8 (group C), 20 with injuries in the upper-middle thoracic cord between T4 and T10 (group UT), and 15 with injuries in the lower thoracic-lumbar cord between T12 and L1 (group TL). Mean age was 34.0 years (range 16-68 years). Of these patients, 13 used the Walkabout, four used the gear joint, and 28 used the Primewalk as the medial hip joint. Recursive partitioning, which predicted the final status of gait from the level, degree of paresis, age, and inhibitory factors, was performed, and a decision tree for gait was constructed. Inhibitory factors were spasticity, involuntary spasms or muscle contractions, pain, contracture, weakness of the upper extremities, and decreased motivation to perform gait exercise. The degree of gait independence was rated on the following five-point scale: outdoor independent gait (5 points), indoor independent gait (4 points), indoor supervised gait (3 points), indoor assisted gait (2 points), and gait within parallel bars (1 point). New branches were added to the decision tree for gait based on the clinical experience, thereby constructing a new decision tree. The coincident ratio between the value predicted on the basis of the decision tree of gait and the value actually observed was 53.3%. The coincident ratio between the value predicted on the basis of the modified decision tree of gait and the actually observed value was 68.9%. The results provide valuable information to medical teams that may assist prescription of

  2. Analysis of swimming pool accidents resulting in spinal cord injury.

    Science.gov (United States)

    Green, B A; Gabrielsen, M A; Hall, W J; O'Heir, J

    1980-04-01

    This paper is a summary of a study of 72 cases of swimming-pool accidents resulting in serious injuries with the potential of permanent disability. Sixty-four of the 72 cases resulted in spinal cord injuries, 57 of which involved quadriplegic lesions. The authors observed that the majority of these injuries resulted from a lack of good judgement and common sense rather than from intoxication or pool structural deficiencies. Also of note was the lack of appropriate first-aid and extrication rendered, as well as the absence of uniform treatment and care received by the majority of the patients.

  3. A review of oscillating field stimulation to treat human spinal cord injury.

    Science.gov (United States)

    Shapiro, Scott

    2014-01-01

    To report the results of use of a human oscillating field stimulator (OFS) in a phase 1 trial of 14 human patients with complete motor and sensory spinal cord injury. Entry criteria were complete spinal cord injury between C5 and T10 in patients 18-65 years old with no transection on magnetic resonance imaging. All patients received the National Acute Spinal Cord Injury Study III methylprednisolone protocol. Cord compression or instability was treated before entry. All patient injuries remained complete (based on American Spinal Cord Injury scoring) with no somatosensory evoked potentials (SSEPs) below the injury after surgery or for 48 hours. All patients were implanted with the OFS within 18 days. Patients were checked every 2 weeks after implantation. The OFS was explanted at 15 weeks. Independent neurologic examinations (American Spinal Cord Injury score, visual analog scale for pain, and SSEPs) were done at 6 weeks, 6 months, and 1 year. Statistical analyses were done by Wilcoxon rank sum test and analysis of variance (ANOVA). There were no complications at insertion, and one wound infection occurred after explant for a 3.5% infection rate. One patient was lost to follow-up after 6 months. All 14 patients had a mean visual analog scale score of 8 at implant and 2 at 6 months, and 13 remained a mean score of 2 at 1 year. Mean improvement in light touch score at 1 year was 25.9 points (ANOVA, P injuries, six had improvement in arm SSEPs, and one recovered a tibial SSEP. Of six patients with thoracic injuries, one recovered an abnormal lower SSEP. Treatment of human spinal cord injury with an OFS is safe, reliable, and easy. Compared with National Acute Spinal Cord Injury Study III compliant paralyzed patients, our results suggest efficacy. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Imatinib enhances functional outcome after spinal cord injury.

    Directory of Open Access Journals (Sweden)

    Mathew B Abrams

    Full Text Available We investigated whether imatinib (Gleevec®, Novartis, a tyrosine kinase inhibitor, could improve functional outcome in experimental spinal cord injury. Rats subjected to contusion spinal cord injury were treated orally with imatinib for 5 days beginning 30 minutes after injury. We found that imatinib significantly enhanced blood-spinal cord-barrier integrity, hindlimb locomotor function, sensorimotor integration, and bladder function, as well as attenuated astrogliosis and deposition of chondroitin sulfate proteoglycans, and increased tissue preservation. These improvements were associated with enhanced vascular integrity and reduced inflammation. Our results show that imatinib improves recovery in spinal cord injury by preserving axons and other spinal cord tissue components. The rapid time course of these beneficial effects suggests that the effects of imatinib are neuroprotective rather than neurorestorative. The positive effects on experimental spinal cord injury, obtained by oral delivery of a clinically used drug, makes imatinib an interesting candidate drug for clinical trials in spinal cord injury.

  5. Cardiac arrhythmias associated with spinal cord injury

    DEFF Research Database (Denmark)

    Hector, Sven Magnus; Biering-Sørensen, Tor; Krassioukov, Andrei;

    2013-01-01

    CONTEXT/OBJECTIVES: To review the current literature to reveal the incidence of cardiac arrhythmias and its relation to spinal cord injury (SCI). METHODS: Data source: MEDLINE database, 304 hits, and 32 articles were found to be relevant. The relevant articles all met the inclusion criteria: (1......) contained original data (2) on cardiac arrhythmias (3) in humans with (4) traumatic SCI. RESULTS: In the acute phase of SCI (1-14 days after injury) more cranial as well as more severe injuries seemed to increase the incidence of bradycardia. Articles not covering the first 14 days after injury, thus...... as during procedures such as penile vibro-stimulation and tracheal suction. These episodes of bradycardia were seen more often in individuals with cervical injuries. Longitudinal studies with continuous electrocardiogram recordings are needed to uncover the true relation between cardiac arrhythmias and SCI....

  6. [ENMG-assessment of efficiency of temporal epidural electroneurostimulation in combined with robotic kinesotherapy in the treatment of patients with spinal cord injury consequences].

    Science.gov (United States)

    Shein, A P; Krivoruchko, G A; Prudnikova, O G

    2015-01-01

    The goal of this study was to ENMG-assess effectiveness of the short combined neurorehabilitation course (temporal epidural stimulation of the spinal cord combined with a robotic kinesotherapy) in the restorative treatment of patients with traumatic spinal cord disease. Before and after completion of the combined instrumental neurorehabilitation (course duration--2-3 weeks) were tested 75 patients with spinal cord injury consequences. The authors used global and stimulation (H-reflex, M-response) electromyography methods. On the ENMG-data basis were calculated indices of sensorimotor deficit (ISD) and their postrehabilitation trends. ENMG-signs of sensorimotor deficit regression in the lower extremities were observed in 46.6% of events, in the upper extremities (if damaged cervical spine)--in 78.6% of events. The stabilizing effect of the used neurorehabilitation technology was identified an average of 24.0% of events. In 18.8% of events, the using of the combined neurorehabilitation technology has been ineffective. As indications for the use of combined neurorehabilitation courses series may be employed ENMG-signs of the partial corticospinal tracts conduction safety and a positive ISD trend after the each course completion.

  7. Diffusion tensor MR imaging in spinal cord injury.

    Science.gov (United States)

    D'souza, Maria M; Choudhary, Ajay; Poonia, Mahesh; Kumar, Pawan; Khushu, Subash

    2017-04-01

    The ability of diffusion tensor imaging (DTI) to complement conventional MR imaging by diagnosing subtle injuries to the spinal cord is a subject of intense research. We attempted to study change in the DTI indices, namely fractional anisotropy (FA) and mean diffusivity (MD) after traumatic cervical spinal cord injury and compared these with corresponding data from a control group of individuals with no injury. The correlation of these quantitative indices to the neurological profile of the patients was assessed. 20 cases of acute cervical trauma and 30 age and sex matched healthy controls were enrolled. Scoring of extent of clinical severity was done based on the Frankel grading system. MRI was performed on a 3T system. Following the qualitative tractographic evaluation of white matter tracts, quantitative datametrics were calculated. In patients, the Mean FA value at the level of injury (0.43+/-0.08) was less than in controls (0.62+/-0.06), which was statistically significant (p value injury (1.30+/-0.24) in cases was higher than in controls (1.07+/-0.12, p value injury (r value=0.86). Negative correlation was found between clinical grade and Mean MD at the level of injury (r value=-0.38) which was however statistically not significant. Quantitative DTI indices are a useful parameter for detection of spinal cord injury. FA value was significantly decreased while MD value was significantly increased at the level of injury in cases as compared to controls. Further, FA showed significant correlation with clinical grade. DTI could thus serve as a reliable objective imaging tool for assessment of white matter integrity and prognostication of functional outcome. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Surgical Neurostimulation for Spinal Cord Injury

    Science.gov (United States)

    Chari, Aswin; Hentall, Ian D.; Papadopoulos, Marios C.; Pereira, Erlick A. C.

    2017-01-01

    Traumatic spinal cord injury (SCI) is a devastating neurological condition characterized by a constellation of symptoms including paralysis, paraesthesia, pain, cardiovascular, bladder, bowel and sexual dysfunction. Current treatment for SCI involves acute resuscitation, aggressive rehabilitation and symptomatic treatment for complications. Despite the progress in scientific understanding, regenerative therapies are lacking. In this review, we outline the current state and future potential of invasive and non-invasive neuromodulation strategies including deep brain stimulation (DBS), spinal cord stimulation (SCS), motor cortex stimulation (MCS), transcutaneous direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) in the context of SCI. We consider the ability of these therapies to address pain, sensorimotor symptoms and autonomic dysregulation associated with SCI. In addition to the potential to make important contributions to SCI treatment, neuromodulation has the added ability to contribute to our understanding of spinal cord neurobiology and the pathophysiology of SCI. PMID:28208601

  9. 女性脊髓损伤后高催乳素血症的研究进展%Hyperprolactinemia in Female Patients with Spinal Cord Injury (review)

    Institute of Scientific and Technical Information of China (English)

    英小倩; 张军卫

    2016-01-01

    Some female spinal cord injured patients may present a raise of serum prolactin which is irrelevant with pregnancy, and re-sults in irregular menstruation and galactorrhea. Hyperprolactinemia may even happen in men after spinal cord injury. This kind of hyperpro-lactinemia does not relate with the level or severity of spinal cord injury, and maintains for various time. The hypersensitivity to thyrotro-pin-releasing hormone may relate to the elevatory serum prolactin and amenorrhea. In addition, there are some suspicious factors, such as chest wall injury, pituitary body contusion, enkephalins increasing, the stimulation of spinal neural pathways, stress, and so on. Bromocripti-ne has been tried for it.%部分非妊娠期女性脊髓损伤患者伤后出现与妊娠无关的血浆催乳素水平升高,表现为不同程度的月经异常、溢乳;部分男性脊髓损伤后也会出现.这种高催乳素血症与脊髓损伤的节段及损伤程度无关,且持续时间各不相同.脊髓损伤后催乳素增高及闭经可能与伤后对促甲状腺激素释放激素反应增强有关.另外,胸部损伤、垂体挫伤、脑内啡肽升高、脊髓神经通路的刺激、应激等都是可疑因素.溴隐亭治疗可能有效.

  10. Motor cortex changes in spinal cord injury: a TMS study.

    Science.gov (United States)

    Saturno, Eleonora; Bonato, Claudio; Miniussi, Carlo; Lazzaro, Vincenzodi; Callea, Leonardo

    2008-12-01

    Using paired pulse transcranial magnetic stimulation (TMS) paradigms, we studied cortical excitability in a patient with spinal cord lesion. During posterior tibial nerve stimulation, the contextual flexion of hand fingers contralateral to the stimulated lower limb had suggested a change in motor cortex excitability. Results showed a decrease in the activity of motor cortex inhibitory circuits. This could suggest that in spinal cord injury, just as in stroke and peripheral deafferentation, a disinhibition of latent synapses within the motor cortex and the rewriting of a new motor map can occur.

  11. Effectiveness of bisphosphonate analogues and functional electrical stimulation on attenuating post-injury osteoporosis in spinal cord injury patients- a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Ke-Vin Chang

    Full Text Available BACKGROUND: Various pharmacologic and non-pharmacologic approaches have been applied to reduce sublesional bone loss after spinal cord injury (SCI, and the results are inconsistent across the studies. The objective of this meta-analysis was to investigate whether the two most-studied interventions, bisphosphonate analogues and functional electrical stimulation (FES, could effectively decrease bone mineral density (BMD attenuation and/or restore lost BMD in the SCI population. METHODS: Randomized controlled trials, quasi-experimental studies, and prospective follow-up studies employing bisphosphonates or FES to treat post-SCI osteoporosis were identified in PubMed and Scopus. The primary outcome was the percentage of BMD change from baseline measured by dual-energy X-ray absorptiometry (DEXA or computed tomography (CT. Data were extracted from four points: the 3rd, 6th, 12th, and 18th month after intervention. RESULTS: A total of 19 studies were included in the analysis and involved 364 patients and 14 healthy individuals. Acute SCI participants treated with bisphosphonate therapy demonstrated a trend toward less bone loss than participants who received placebos or usual care. A significant difference in BMD decline was noted between both groups at the 3rd and 12th month post-medication. The subgroup analysis failed to show the superiority of intravenous bisphosphonate over oral administration. Regarding FES training, chronic SCI patients had 5.96% (95% CI, 2.08% to 9.84%, 7.21% (95%CI, 1.79% to 12.62%, and 9.56% (95% CI, 2.86% to 16.26% increases in BMD at the 3rd, 6th, and 12th months post-treatment, respectively. The studies employing FES ≥ 5 days per week were likely to have better effectiveness than studies using FES ≤ 3 days per week. CONCLUSIONS: Our meta-analysis indicated bisphosphonate administration early following SCI effectively attenuated sublesional bone loss. FES intervention for chronic SCI patients could significantly

  12. Gene therapy approaches for spinal cord injury

    Science.gov (United States)

    Bright, Corinne

    As the biomedical engineering field expands, combination technologies are demonstrating enormous potential for treating human disease. In particular, intersections between the rapidly developing fields of gene therapy and tissue engineering hold promise to achieve tissue regeneration. Nonviral gene therapy uses plasmid DNA to deliver therapeutic proteins in vivo for extended periods of time. Tissue engineering employs biomedical materials, such as polymers, to support the regrowth of injured tissue. In this thesis, a combination strategy to deliver genes and drugs in a polymeric scaffold was applied to a spinal cord injury model. In order to develop a platform technology to treat spinal cord injury, several nonviral gene delivery systems and polymeric scaffolds were evaluated in vitro and in vivo. Nonviral vector trafficking was evaluated in primary neuronal culture to develop an understanding of the barriers to gene transfer in neurons and their supporting glia. Although the most efficient gene carrier in vitro differed from the optimal gene carrier in vivo, confocal and electron microscopy of these nonviral vectors provided insights into the interaction of these vectors with the nucleus. A novel pathway for delivering nanoparticles into the nuclei of neurons and Schwann cells via vesicle trafficking was observed in this study. Reporter gene expression levels were evaluated after direct and remote delivery to the spinal cord, and the optimal nonviral vector, dose, and delivery strategy were applied to deliver the gene encoding the basic fibroblast growth factor (bFGF) to the spinal cord. An injectable and biocompatible gel, composed of the amphiphillic polymer poly(ethylene glycol)-poly(epsilon-caprolactone)-poly(ethylene glycol) (PEG-PCL-PEG) was evaluated as a drug and gene delivery system in vitro, and combined with the optimized nonviral gene delivery system to treat spinal cord injury. Plasmid DNA encoding the bFGF gene and the therapeutic NEP1--40 peptide

  13. Functional independence and health-related functional status following spinal cord injury : a prospective study of the association with physical capacity

    NARCIS (Netherlands)

    Haisma, Janneke A.; Post, Marcel W.; van der Woude, Lucas H.; Stam, Henk J.; Bergen, Michael P.; Sluis, Tebbe A.; van den Berg-Emons, Hendrika J.; Bussmann, Johannes B.

    2008-01-01

    Objective: To determine changes in functional independence following spinal cord injury and to evaluate the association between functional independence and physical capacity. Design: Multi-centre prospective cohort study. Subjects: Patients with spinal cord injury admitted for initial rehabilitation

  14. Parents with a spinal cord injury

    DEFF Research Database (Denmark)

    Rasul, A; Biering-Sørensen, F

    2016-01-01

    STUDY DESIGN: This is a cross-sectional questionnaire. OBJECTIVES: The objective of this study was to describe the impact of parenting young children with a spinal cord injury (SCI) on various life situations (for example, personal, vocational and social). SETTING: Community; Denmark. METHODS......: A postal survey was designed to collect data in persons with SCI regarding the following: (1) socio-demographics, injury characteristics and parental status; (2) employment status; (3) environmental adjustments to support parenting roles; (4) childcare institution use and experiences; (5) network support...

  15. Restoring function after spinal cord injury: towards clinical translation of experimental strategies.

    Science.gov (United States)

    Ramer, Leanne M; Ramer, Matt S; Bradbury, Elizabeth J

    2014-12-01

    Spinal cord injury is currently incurable and treatment is limited to minimising secondary complications and maximising residual function by rehabilitation. Improved understanding of the pathophysiology of spinal cord injury and the factors that prevent nerve and tissue repair has fuelled a move towards more ambitious experimental treatments aimed at promoting neuroprotection, axonal regeneration, and neuroplasticity. By necessity, these new options are more invasive. However, in view of recent advances in spinal cord injury research and demand from patients, clinicians, and the scientific community to push promising experimental treatments to the clinic, momentum and optimism exist for the translation of candidate experimental treatments to clinical spinal cord injury. The ability to rescue, reactivate, and rewire spinal systems to restore function after spinal cord injury might soon be within reach. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Present situation and prospect of post-discharge bladder function support of patients with spinal cord injury%脊髓损伤患者出院后膀胱功能支持现状的研究进展

    Institute of Scientific and Technical Information of China (English)

    刘秀梅; 黎婷

    2016-01-01

    Spinal cord injury is severely disabling. In developed countries, the incidence of spinal cord injury is 11.5% - 53.4% per million population. The quality of life of patients with spinal cord injury and their survival rates in China are lower than that of developed countries, however the urinary tract complication is the first cause of their late death. Comparing the bladder function training and rehabilitation at home and abroad, the major causes of lower bladder function rehabilitation and aftercare level in China may be associated with the following aspects:imperfect rehabilitation health care system, lack of professional talents, weak rehabilitation consciousness, etc. So the fundamental measures to improve the bladder function rehabilitation include the improvement of rehabilitation health care system and professional training of rehabilitation team, and participation of orthopedic doctors in the rehabilitation training guidance of patients and their families.

  17. Comparison of efficacies of vegetable oil based and polyethylene glycol based bisacodyl suppositories in treating patients with neurogenic bowel dysfunction after spinal cord injury: a meta-analysis.

    Science.gov (United States)

    Yi, Zhu; Jie, Cheng; Wenyi, Zhang; Bin, Xie; Hongzhu, Jin

    2014-10-01

    We performed a meta-analysis to compare the efficacies of vegetable oil based bisacodyl (VOB) and polyethylene glycol based bisacodyl (PGB) suppositories in treating patients with neurogenic bowel dysfunction (NBD) after spinal cord injury (SCI). Relevant clinical studies (up to February 2014) were retrieved through the following databases: PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CCTR), Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wanfang, and VIP database for Chinese Technical Periodicals. Data were analyzed using the standardized weighted mean difference (SMD) and its 95% confidence interval (CI). P-values 0.05) between patients in the PGB and VOB groups. Based on the results, we conclude that the PGB suppository could act faster than the VOB suppository in the treatment of NBD in patients with SCI.

  18. Acute spinal cord injury and neurogenic shock in pregnancy.

    Science.gov (United States)

    Gilson, G J; Miller, A C; Clevenger, F W; Curet, L B

    1995-07-01

    A case of a pregnant woman with a subluxation of C-6 on C-7 with acute quadriplegia and sensory loss to the T-10 dermatome is described. Hemodynamic and fetal monitoring during the 3-week period of neurogenic shock resulted in good maternal and fetal outcomes. Pulmonary complications and anesthetic issues are important aspects of the care of these critically ill patients. Major trauma is a common cause of death and disability in young adults and may contribute to as much as 15 percent of nonobstetric maternal deaths. Spinal cord injuries involve young women in 15 percent of cases. The literature is replete with information on the obstetric management of patients with preexisting spinal cord injury (1-4) but there is little on the management and special problems of the pregnant patient with acute spinal cord trauma. We report here the management of a case of acute cord transection accompanied by spinal shock and discuss the specific maternal as well as fetal considerations in this syndrome.

  19. Index of CD34+ Cells and Mononuclear Cells in the Bone Marrow of Spinal Cord Injury Patients of Different Age Groups: A Comparative Analysis

    Directory of Open Access Journals (Sweden)

    Vidyasagar Devaprasad Dedeepiya

    2012-01-01

    Full Text Available Introduction. Recent evidence of safety and efficacy of Bone Marrow Mononuclear Cells (BMMNC in spinal cord injury makes the Bone Marrow (BM CD34+ percentage and the BMMNC count gain significance. The indices of BM that change with body mass index and aging in general population have been reported but seldom in Spinal Cord Injury (SCI victims, whose parameters of relevance differ from general population. Herein, we report the indices of BMMNC in SCI victims. Materials and Methods. BMMNCs of 332 SCI patients were isolated under GMP protocols. Cell count by Trypan blue method and CD34+ cells by flow cytometry were documented and analysed across ages and gender. Results. The average BMMNC per ml in the age groups 0–20, 21–40, 41–60, and 61–80 years were 4.71, 4.03, 3.67, and 3.02 million and the CD34+ were 1.05%, 1.04%, 0.94%, and 0.93% respectively. The decline in CD34+ was sharp between 20–40 and 40–60 age groups. Females of reproductive age group had lesser CD34+. Conclusion. The BMMNC and CD34+ percentages decline with aging in SCI victims. Their lower values in females during reproductive age should be analysed for relevance to hormonal influence. This study offers reference values of BMMNC and CD34+ of SCI victims for successful clinical application.

  20. Imaging diagnosis of cervical spine and spinal cord injuries in children

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To provide the experience in imaging diagnosis of cervical spine and spinal cord injuries in children.Methods: Imaging data of cervical spine and spinal cord injuries in 62 children were retrospectively reviewed.The routine radiography including the lateral,anteroposterior and open-mouth odontoid views were performed in all the patients. Tomography was available for 25 patients, and flexion-extension lateral views for 28patients, CT scanning for 21 patients, MRI for 26 patients.Results: Of these patients, 46 patients were identified with injuries of upper cervical spine (9 with atlantal arch fracture, seven with axial fracture, 21 with odontoid fracture, 1 with atlantal arch fracture combining with odontoid fracture, and 1 with atlantal transverse ligament disruption); 7 patients sustained injuries of lower cervical spine (3 fractures of vertebral body, 2 dislocations and 6fracture-dislocations ); 2 patients had multiple noncontiguous cervical injuries; and 3 had cervical spinal cord injury without radiographic abnormalities (SCIWORA).Conclusions: Imaging assessment is of great importance in the diagnosis of cervical spine and spinal cord injuries in children. Whenever cervical spine and spinal cord injuries are suspected for children patients, and the three-views should be routinely indicated. MRI should be routinely performed in all children with cervical SCIWORA.

  1. Human umbilical cord blood stem cell transplantation for the treatment of chronic spinal cord injury Electrophysiological changes and long-term efficacy

    Institute of Scientific and Technical Information of China (English)

    Liqing Yao; Chuan He; Ying Zhao; Jirong Wang; Mei Tang; Jun Li; Ying Wu; Lijuan Ao; Xiang Hu

    2013-01-01

    Stem cell transplantation can promote functional restoration following acute spinal cord injury (injury time 6 months) were treated with human umbilical cord blood stem cells via intravenous and intrathecal injection. The follow-up period was 12 months after transplantation. Results found that autonomic nerve functions were restored and the latent period of somatosensory evoked potentials was reduced. There were no severe adverse reactions in patients following stem cell transplantation. These experimental findings suggest that the transplantation of human umbilical cord blood stem cells is a safe and effective treatment for patients with traumatic spinal cord injury.

  2. Targeted Iron Chelation Will Improve Recovery after Spinal Cord Injury

    Science.gov (United States)

    2014-10-01

    Neuroprotection Ferritin Introduction recovery after traumatic spinal cord injury (SCI). An optimal treatment to reverse or prevent damage...Hider and Zhou, 2005). However, this intracellular chelation may still be beneficial by preventing free iron from participating in free radical...active iron-chelating agent in patients with transfusion-dependent iron overload due to beta- thalassemia . J. Clin. Pharmacol. 43 (6), 565-572. Hider

  3. The effect of Normast (PEA) in neuropathic pain in spinal cord injury

    DEFF Research Database (Denmark)

    Andresen, Sven Robert; Bing, Jette; Hansen, Rikke Bod Middelhede

    2015-01-01

    Introduction: Neuropathic pain and spasticity after spinal cord injury represent significant problems. Palmitoylethanolamide (PEA) is a fatty acid that is produced in many cells in the body, and it is thought to potentiate the body's own cannabis-like substances (endocannabinoids). PEA is suggested...... and psychological functioning in patients with spinal cord injury. Methods: A randomized, double-blind, placebo-controlled parallel multicenter study. We have included 66 patients with neuropathic pain due to spinal cord injury. Questionnaires regarding neuropathic pain, spasticity, insomnia, anxiety and depression...

  4. Usefulness of Dynamic Urethral Resistance Relation (DURR) measurement for differential diagnosis between static and dynamic urinary obstruction in male spinal cord injury patients.

    Science.gov (United States)

    Vírseda, Miguel; Salinas, Jesús; López, Antonio; Esteban, Manuel

    2012-04-01

    To study the validity of Dynamic Urethral Resistance Relation (DURR) for differential diagnosis between static and dynamic urinay obstruction in male spinal cord injury patients. A case-control study was conducted. The case group consisted of 24 male patients with spinal cord injury, aged under 40 years, with detrusor-periurethral sphincter dyssynergia and bladder outlet obstruction (BOO) according to the urethral resistance factor (URA). The control group consisted of 24 male patients with no neurological lesions, aged over 49 years, diagnosis of benign prostatic hyperplasia (BPH) and BOO according to Schäfer's minimum urethral opening pressure (Pmuo) and the URA. A pressure/flow study was performed in both groups, and the DURR was recorded graphically. Both groups showed significantly different DURR characteristics with respect to the number of spikes (higher in the case group), the intensity of the first three spikes and the maximum duration of the spikes (significantly longer in the case group). The patients in the case group had a DURR characterized by at least three spikes, located throughout the whole voiding cycle (pattern A). The patients in the control group had a DURR mainly characterized by a spike located at the start of micturition and a maximum second spike located at the end of micturition (pattern B). Pattern A showed a sensitivity with respect to the dynamic obstruction of 79% and a specificity of 100%. The sensitivity of pattern B with respect to the diagnosis of static obstruction was 71% and the specificity was 100%. Copyright © 2012 Wiley Periodicals, Inc.

  5. Fatal Renal Failure in a Spinal Cord Injury Patient with Vesicoureteric Reflux Who Underwent Repeated Ureteric Reimplantations Unsuccessfully: Treatment Should Focus on Abolition of High Intravesical Pressures rather than Surgical Correction of Reflux

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2012-01-01

    Full Text Available A 29-year-old man developed paraplegia at T-10 level due to road traffic accident in 1972. Both kidneys were normal and showed good function on intravenous urography. Division of external urethral sphincter was performed in 1973. In 1974, cystogram showed retrograde filling of left renal tract, which was hydronephrotic. Left ureteric reimplantation was performed. Following surgery, cystogram revealed marked retrograde filling of left renal tract as before. Penile sheath drainage was continued. In 1981, intravenous urography revealed bilateral severe hydronephrosis. Left ureteric reimplantation was performed again in 1983. Blood pressure was 220/140 mm Hg; this patient was prescribed atenolol. Cystogram showed gross left vesicoureteral reflux. Intermittent catheterisation was commenced in 2001. In 2007, proteinuria was 860 mg/day. This patient developed progressive renal failure and expired in 2012. In a spinal cord injury patient with vesicoureteral reflux, the treatment should focus on abolition of high intravesical pressures rather than surgical correction of vesicoureteric reflux. Detrusor hyperactivity and high intravesical pressures are the basic causes for vesicoureteral reflux in spinal cord injury patients. Therefore, it is important to manage spinal cord injury patients with neuropathic bladder by intermittent catheterisations along with antimuscarinic drug therapy in order to abolish high detrusor pressures and prevent vesicoureteral reflux. Angiotensin-converting enzyme inhibitors or angiotensin-receptor-blocking agents should be prescribed even in the absence of hypertension when a spinal cord injury patient develops vesicoureteral reflux and proteinuria.

  6. HOMICIDE BY CERVICAL SPINAL CORD GUNSHOT INJURY WITH SHOTGUN FIRE PELLETS: CASE REPORT

    Directory of Open Access Journals (Sweden)

    Dana Turliuc, Serban Turliuc, Iustin Mihailov, Andrei Cucu, Gabriel Dumitrescu,Claudia Costea

    2015-10-01

    Full Text Available This case present a rare forensic case of cervical spinal gunshot injury of a female by her husband, a professional hunter, during a family fight with a shotgun fire pellets. The gunshot destroyed completely the cervical spinal cord, without injury to the neck vessels and organs and with the patient survival for seven days. We discuss notions of judicial ballistics, assessment of the patient with spinal cord gunshot injury and therapeutic strategies. Even if cervical spine gunshot injuries are most of the times lethal for majority of patients, the surviving patients need the coordination of a multidisciplinary surgical team to ensure the optimal functional prognostic.

  7. Spinal cord injury reveals multilineage differentiation of ependymal cells.

    Science.gov (United States)

    Meletis, Konstantinos; Barnabé-Heider, Fanie; Carlén, Marie; Evergren, Emma; Tomilin, Nikolay; Shupliakov, Oleg; Frisén, Jonas

    2008-07-22

    Spinal cord injury often results in permanent functional impairment. Neural stem cells present in the adult spinal cord can be expanded in vitro and improve recovery when transplanted to the injured spinal cord, demonstrating the presence of cells that can promote regeneration but that normally fail to do so efficiently. Using genetic fate mapping, we show that close to all in vitro neural stem cell potential in the adult spinal cord resides within the population of ependymal cells lining the central canal. These cells are recruited by spinal cord injury and produce not only scar-forming glial cells, but also, to a lesser degree, oligodendrocytes. Modulating the fate of ependymal progeny after spinal cord injury may offer an alternative to cell transplantation for cell replacement therapies in spinal cord injury.

  8. Spinal cord injury reveals multilineage differentiation of ependymal cells.

    Directory of Open Access Journals (Sweden)

    Konstantinos Meletis

    2008-07-01

    Full Text Available Spinal cord injury often results in permanent functional impairment. Neural stem cells present in the adult spinal cord can be expanded in vitro and improve recovery when transplanted to the injured spinal cord, demonstrating the presence of cells that can promote regeneration but that normally fail to do so efficiently. Using genetic fate mapping, we show that close to all in vitro neural stem cell potential in the adult spinal cord resides within the population of ependymal cells lining the central canal. These cells are recruited by spinal cord injury and produce not only scar-forming glial cells, but also, to a lesser degree, oligodendrocytes. Modulating the fate of ependymal progeny after spinal cord injury may offer an alternative to cell transplantation for cell replacement therapies in spinal cord injury.

  9. RhoA/Rho kinase in spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    Xiangbing Wu; Xiao-ming Xu

    2016-01-01

    A spinal cord injury refers to an injury to the spinal cord that is caused by a trauma instead of diseases. Spinal cord injury includes a primary mechanical injury and a much more complex secondary injury pro-cess involving inlfammation, oxidation, excitotoxicity, and cell death. During the secondary injury, many signal pathways are activated and play important roles in mediating the pathogenesis of spinal cord injury. Among them, the RhoA/Rho kinase pathway plays a particular role in mediating spinal degeneration and regeneration. In this review, we will discuss the role and mechanism of RhoA/Rho kinase-mediated spinal cord pathogenesis, as well as the potential of targeting RhoA/Rho kinase as a strategy for promoting both neuroprotection and axonal regeneration.

  10. Effectiveness of transcranial direct current stimulation and visual illusion on neuropathic pain in spinal cord injury

    National Research Council Canada - National Science Library

    Soler, Maria Dolors; Kumru, Hatice; Pelayo, Raul; Vidal, Joan; Tormos, Josep Maria; Fregni, Felipe; Navarro, Xavier; Pascual-Leone, Alvaro

    2010-01-01

    ... with neuropathic pain following spinal cord injury. In a sham controlled, double-blind, parallel group design, 39 patients were randomized into four groups receiving transcranial direct current stimulation with walking visual illusion or with control...

  11. The physiological basis of neurorehabilitation--locomotor training after spinal cord injury

    National Research Council Canada - National Science Library

    Hubli, Michèle; Dietz, Volker

    2013-01-01

    Advances in our understanding of the physiological basis of locomotion enable us to optimize the neurorehabilitation of patients with lesions to the central nervous system, such as stroke or spinal cord injury (SCI...

  12. Sleep disordered breathing following spinal cord injury

    DEFF Research Database (Denmark)

    Biering-Sørensen, Fin; Jennum, Poul; Laub, Michael

    2009-01-01

    Individuals with spinal cord injury (SCI) commonly complain about difficulty in sleeping. Although various sleep disordered breathing definitions and indices are used that make comparisons between studies difficult, it seems evident that the frequency of sleep disorders is higher in individuals...... with SCI, especially with regard to obstructive sleep apnea. In addition, there is a correlation between the incidence of sleep disturbances and the spinal cord level injured, age, body mass index, neck circumference, abdominal girth, and use of sedating medications. Regulation of respiration is dependent...... on wakefulness and sleep. Thus, it is important to be aware of basic mechanisms in the regulation and control of sleep and awake states. Supine position decreases the vital capacity in tetraplegic individuals, and diminished responsiveness to Pa(CO)(2) may further decrease ventilatory reserve. There also may...

  13. Methylprednisolone– acute spinal cord injury, benefits or risks? 

    Directory of Open Access Journals (Sweden)

    Maciej Tęsiorowski

    2013-06-01

    Full Text Available Methylprednisolone is a synthetic glucocorticoid with a potent and long-acting anti-inflammatory, antiallergic and immunosuppressant. Its mechanism of action of methylprednisolone is the result of many cellular changes. Methylprednisolone is used in many diseases, such as rheumatic diseases, autoimmune diseases, allergic, anaphylactic shock, asthma. Methylprednisolone was also used in patients with spinal cord injury, in order to minimize neurological damage. While in the above mentioned fields of medicine is undeniable role of methylprednisolone, whereas its use in the treatment of traumatic spinal cord injury within the last few years raises a lot of controversy, and in most cases, the side effects of its use outweigh the potential benefits. 

  14. International Standards for Neurological Classification of Spinal Cord Injury

    DEFF Research Database (Denmark)

    Kirshblum, S C; Biering-Sorensen, F; Betz, R

    2014-01-01

    The International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) is routinely used to determine the levels of injury and to classify the severity of the injury. Questions are often posed to the International Standards Committee of the American Spinal Injury Associat......The International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) is routinely used to determine the levels of injury and to classify the severity of the injury. Questions are often posed to the International Standards Committee of the American Spinal Injury...

  15. Amitriptyline pharmacokinetics in experimental spinal cord injury in the rabbit

    Directory of Open Access Journals (Sweden)

    Reihanikermani H

    2008-01-01

    Full Text Available Previous studies have demonstrated that pharmacokinetic behavior of several drugs such as paracetamol, theophylline, and aminoglycosides are significantly altered in spinal cord injured patients. No pharmacokinetic study of amitriptyline has been performed in patients and experimental models of spinal cord injury. Pharmacokinetic parameters of amitriptyline in orally treated rabbits subjected to laminectomy and spinal cord injury compared with those underwent laminectomy alone. Among twenty four male rabbits were included in this study, nine of them subjected to spinal cord injury at the 8 th thoracic level by knife severance method and six rabbits underwent laminectomy alone (sham group and nine rabbits treated as control. All received a single oral dose of amitriptyline (20 mg/kg 24 h after injury. Blood sampling were done at predetermined times to 36 h after drug administration. Amitriptyline concentration in serum samples was determined by high-performance liquid chromatography. Pharmacokinetic parameters including maximum concentration (C max , time to reach maximum concentration (T max , half life, and the area under the curve to last detectable concentration time point (AUC 0-t were directly determined from the concentration-time curve. Maximum concentration was observed at 6.5 h after administration in sham group with a concentration of 439.6 ng/ml, whereas in SCI group T max was at 2.7 h with a concentration of 2763.9 ng/ml. In control group it was 3.3 h and 396 ng/ml, respectively. In SCI group, AUC was 9465.6 ng.h/ml and half life was 6 h and for control group it was 2817.4 ng.h/ml and 6.4 h, respectively. Statistical analysis of data showed that SCI didn′t induce significant changes in amitriptyline pharmacokinetic parameters.

  16. One-year clinical study of NeuroRegen scaffold implantation following scar resection in complete chronic spinal cord injury patients.

    Science.gov (United States)

    Xiao, Zhifeng; Tang, Fengwu; Tang, Jiaguang; Yang, Huilin; Zhao, Yannan; Chen, Bing; Han, Sufang; Wang, Nuo; Li, Xing; Cheng, Shixiang; Han, Guang; Zhao, Changyu; Yang, Xiaoxiong; Chen, Yumei; Shi, Qin; Hou, Shuxun; Zhang, Sai; Dai, Jianwu

    2016-07-01

    The objective of this clinical study was to assess the safety and feasibility of the collagen scaffold, NeuroRegen scaffold, one year after scar tissue resection and implantation. Scar tissue is a physical and chemical barrier that prevents neural regeneration. However, identification of scar tissue is still a major challenge. In this study, the nerve electrophysiology method was used to distinguish scar tissue from normal neural tissue, and then different lengths of scars ranging from 0.5-4.5 cm were surgically resected in five complete chronic spinal cord injury (SCI) patients. The NeuroRegen scaffold along with autologous bone marrow mononuclear cells (BMMCs), which have been proven to promote neural regeneration and SCI recovery in animal models, were transplanted into the gap in the spinal cord following scar tissue resection. No obvious adverse effects related to scar resection or NeuroRegen scaffold transplantation were observed immediately after surgery or at the 12-month follow-up. In addition, patients showed partially autonomic nervous function improvement, and the recovery of somatosensory evoked potentials (SSEP) from the lower limbs was also detected. The results indicate that scar resection and NeuroRegen scaffold transplantation could be a promising clinical approach to treating SCI.

  17. Co-transplantation of autologous bone marrow mesenchymal stem cells and Schwann cells through cerebral spinal fluid for the treatment of patients with chronic spinal cord injury: safety and possible outcome.

    Science.gov (United States)

    Oraee-Yazdani, S; Hafizi, M; Atashi, A; Ashrafi, F; Seddighi, A-S; Hashemi, S M; Seddighi, A; Soleimani, M; Zali, A

    2016-02-01

    This is a clinical trial (phase 1). The objective of this study was to asses the safety and feasibility of bone marrow mesenchymal stem cell (MSC) and Schwann cell (SC) co-injection through cerebral spinal fluid (CSF) for the treatment of patients with chronic spinal cord injury. Six subjects with complete spinal cord injury due to trauma according to International Standard of Neurological Classification for Spinal Cord Injury (ISNCSCI) developed by the American Spinal Injury Association were enrolled. They received autologous co-transplantation of MSC and SC through lumbar puncture. Neurological status of the patients was determined by ISNCSCI, as well as by assessment of functional status by Spinal Cord Independent Measure. Before and after cell transplantation, magnetic resonance imaging (MRI) was performed for all the patients. Before the procedure, all the patients underwent electromyography, urodynamic study (UDS) and MRI tractograghy. After transplantation, these assessments were performed in special cases when the patients reported any changes in motor function or any changes in urinary sensation. Over the mean 30 months of follow-up, the radiological findings were unchanged without any evidence of neoplastic tissue overgrowth. American Spinal Injury Association class in one patient was changed from A to B, in addition to the improvement in indexes of UDS, especially bladder compliance, which was congruous with axonal regeneration detected in MRI tractography. No motor score improvement was observed among the patients. No adverse findings were detected at a mean of 30 months after autologous transplantation of the combination of MSCs and SCs through CSF. It may suggest the safety of this combination of cells for spinal cord regeneration.

  18. Damage control of multiple injuries headed by cervical spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    LIU Si-hai; WANG Ai-min; DU Quan-yin; ZHAO Yu-feng; WANG Zi-ming; GUO Qing-shan; SHEN Yue

    2008-01-01

    Objective: To explore the strategy of damage control in clinical treatment of multiple injuries headed by cervical spinal cord injury.Methods: A retrospective analysis was performed in 32 patients. Cervical fractures associated with tetraplegia occurred in 18 patients, traumatic intervertebral disk hernia associated with tetraplegia in 2 patients, and cervical fractures and dislocation associated with tetraplegia in 12 patients. Seventeen cases were combined with craniocerebral injury, 7 combined with pulmonary contusion, multi-fractures of rib or hemopneumothorax, 2 combined with pelvic fracture and other 8 combined with fracture of limbs. The neural function was assessed by the American Spinal Injury Association (ASIA) scale.Results:Thirty-one patients were followed up for an average of 14 months. Of them, 10 got complete recovery, 13 obtained improvement of more than one ASIA grade, 8 did not improve, and 1 died.Conclusions: For the emergency treatment of multiple injuries headed by cervical spinal cord injury, the damage control strategy is the principle to follow. The final operations are preferably performed within 5 to 10 days after injury so as to raise the successful rate of remedy.

  19. Immunotherapy strategies for spinal cord injury.

    Science.gov (United States)

    Wang, Yong-Tang; Lu, Xiu-Min; Chen, Kai-Ting; Shu, Ya-Hai; Qiu, Chun-Hong

    2015-01-01

    Regeneration in the central nervous system (CNS) of adult mammalian after traumatic injury is limited, which often causes permanent functional motor and sensory loss. After spinal cord injury (SCI), the lack of regeneration is mainly attributed to the presence of a hostile microenvironment, glial scarring, and cavitation. Besides, inflammation has also been proved to play a crucial role in secondary degeneration following SCI. The more prominent treatment strategies in experimental models focus mainly on drugs and cell therapies, however, only a few strategies applied in clinical studies and therapies still have only limited effects on the repair of SCI. Recently, the interests in immunotherapy strategies for CNS are increasing in number and breadth. Immunotherapy strategies have made good progresses in treating many CNS degenerative disorders, such as Alzheimer's disease (AD), Parkinson's disease (PD), stroke, and multiple sclerosis (MS). However, the strategies begin to be considered to the treatment of SCI and other neurological disorders in recent years. Besides anti-inflamatory therapy, immunization with protein vaccines and DNA vaccines has emerged as a novel therapy strategy because of the simplicity of preparation and application. An inflammatory response followed by spinal cord injury, and is controled by specific signaling molecules, such as some cytokines playing a crucial role. As a result, appropriate immunoregulation, the expression of pro-inflammatory cytokines and anti-inflammatory cytokines may be an effective therapy strategy for earlier injury of spinal cord. In addition, myelinassociated inhibitors (MAIs) in the injured spinal cord, such as Nogo, myelin-associated glycoprotein (MAG) and oligodendrocyte- myelin glycoprotein (OMgp) are known to prevent axonal regeneration through their co-receptors, and to trigger demyelinating autoimmunity through T cell-mediated harmful autoimmune response. The antagonism of the MAIs through vaccinating with

  20. Effect of Alpha-1-Adrenergic Agonist, Midodrine for the Management of Long-Standing Neurogenic Shock in Patient with Cervical Spinal Cord Injury: A Case Report.

    Science.gov (United States)

    Kim, Taikwan; Jwa, Cheol Su

    2015-10-01

    We report a rare case of a 71-year-old male patient who had suffered from long-lasting neurogenic shock for 13 weeks after cervical spinal cord injury (SCI) caused by a bicycle accident. The neurogenic shock was resolved dramatically 2 weeks after the administration of alpha-1-adrenergic agonist, midodrine hydrochloride. In usual cases, neurogenic shock tends to improve between 2 and 6 weeks after SCI; however, in a few cases, the shock lasts for several months. In our case, spinal shock lasted for 13 weeks and exhibited very sensitive decline of blood pressure for even a slight decrease of dopamine despite recovered bulbospongiosus reflex. Three days after midodrine hydrochloride was added, hypotension improved dramatically. We discuss our rare case with pertinent literatures.

  1. Civilian spinal cord injuries due to terror explosions.

    Science.gov (United States)

    Zeilig, G; Weingarden, H P; Zwecker, M; Rubin-Asher, D; Ratner, A; Ohry, A

    2010-11-01

    Retrospective analysis of civilians with spinal cord injuries (SCIs) due to terror explosions. To analyze and describe the clinical characteristics and rehabilitation outcomes of civilians with SCI due to explosions admitted for in-patient rehabilitation from 2000-2004. SCI rehabilitation service, Tel Hashomer, Israel. Retrospective chart review. Civilians with SCI due to terror-related gunshot wounds (GSWs) served as a control group. Eleven civilians with SCI caused by penetrating atypical foreign objects (PAFOs) and eight with GSWs were identified. The male-to-female ratio was approximately 2:1. Foreign objects were present within the spinal canal in seven patients, causing bone injury without canal penetration in three, and one patient had both bone injury and canal penetration. The most common level of injury was thoracic. Seven had complete motor SCI. Three individuals improved in American Spinal Injury Association status: one individual improved from B to C (cervical); one from C to D (thoracic); and the third from D to E (lumbar). Despite the similar acute hospital length of stay and functional independence measure (FIM) scores on admission, the PAFO group had a shorter rehabilitation length of stay with higher FIM scores and higher FIM efficiency at discharge. Although the pathophysiology of PAFO blast injuries is similar to the high-velocity GSWs or the high-energy military munition injuries, better rehabilitation outcomes were seen, with slightly higher FIM efficiency and efficacy at discharge. This result is likely to be caused by less neurological tissue damage at impact.

  2. Transcranial Magnetic Stimulation with Intermittent Theta Burst Stimulation Alters Corticospinal Output in Patients with Chronic Incomplete Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Hunter J. Fassett

    2017-08-01

    Full Text Available Intermittent theta burst stimulation (iTBS is intended primarily to alter corticospinal excitability, creating an attractive opportunity to alter neural output following incomplete spinal cord injury (SCI. This study is the first to assess the effects of iTBS in SCI. Eight individuals with chronic incomplete SCI were studied. Sham or real iTBS was delivered (to each participant over primary motor and somatosensory cortices in separate sessions. Motor-evoked potential (MEP recruitment curves were obtained from the flexor carpi radialis muscle before and after iTBS. Results indicate similar responses for iTBS to both motor and somatosensory cortex and reduced MEPs in 56.25% and increased MEPs in 25% of instances. Sham stimulation exceeded real iTBS effects in the remaining 18.25%. It is our opinion that observing short-term neuroplasticity in corticospinal output in chronic SCI is an important advance and should be tested in future studies as an opportunity to improve function in this population. We emphasize the need to re-consider the importance of the direction of MEP change following a single session of iTBS since the relationship between MEP direction and motor function is unknown and multiple sessions of iTBS may yield very different directional results. Furthermore, we highlight the importance of including sham control in the experimental design. The fundamental point from this pilot research is that a single session of iTBS is often capable of creating short-term change in SCI. Future sham-controlled randomized trials may consider repeat iTBS sessions to promote long-term changes in corticospinal excitability.

  3. Human umbilical cord mesenchymal stem cells and the treatment of spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    CAO Fu-jiang; FENG Shi-qing

    2009-01-01

    Objective To review the recent studies about human umbilical cord mesenchymal stem cells (hUCMSCs) and advances in the treatment of spinal cord injury, Data sources Published articles (1983-2007) about hUCMSCs and spinal cord injury were selected using Medline. Study selection Articles selected were relevant to development of mesenchymal stem cells (MSCs) for transplantation in spinal cord injury therapy. Of 258 originally identifiied arises 51 were selected that specifically addressed the stated purpose. Results Recent work has revealed that hUCMSCs share most of the characteristics with MSCs derived from bone marrow and are more appropriate to transplantation for cell based therapies. Conclusions Human umbilical cord could be regarded as a source of MSCs for experimental and clinical needs. In addition, as a peculiar source of stem cells, hUCMSCs may play an important role in the treatment of spinal cord injury.

  4. Inpatient treatment time across disciplines in spinal cord injury rehabilitation

    Science.gov (United States)

    Whiteneck, Gale; Gassaway, Julie; Dijkers, Marcel; Backus, Deborah; Charlifue, Susan; Chen, David; Hammond, Flora; Hsieh, Ching-Hui; Smout, Randall J.

    2011-01-01

    Background/objective Length of stay (LOS) for rehabilitation treatment after spinal cord injury (SCI) has been documented extensively. However, there is almost no published research on the nature, extent, or intensity of the various treatments patients receive during their stay. This study aims at providing such information on a large sample of patients treated by specialty rehabilitation inpatient programs. Methods Six hundred patients with traumatic SCI admitted to six rehabilitation centers were enrolled. Time spent on various therapeutic activities was documented by each rehabilitation clinician after each patient encounter. Patients were grouped by neurologic level and completeness of injury. Total time spent by each rehabilitation discipline over a patient's stay and total minutes of treatment per week were calculated. Ordinary least squares stepwise regression models were used to identify patient and injury characteristics associated with time spent in rehabilitation treatment overall and within each discipline. Results Average LOS was 55 days (standard deviation 37), during which 180 (106) hours of treatment were received, or 24 (5) hours per week. Extensive variation was found in the amount of treatment received, between and within neurologic groups. Total hours of treatment provided throughout a patient's stay were primarily determined by LOS, which in turn was primarily predicted by medical acuity. Variation in minutes per week of treatment delivered by individual disciplines was predicted poorly by patient and injury characteristics. Conclusions Variations between and within SCI rehabilitation patient groups in LOS, minutes of treatment per week overall, and for each rehabilitation discipline are large. Variation in treatment intensity was not well explained by patient and injury characteristics. In accordance with practice-based evidence methodology, the next step in the SCIRehab study will be to determine which treatment interventions are related with

  5. International Spinal Cord Injury Male Sexual Function Basic Data Set

    DEFF Research Database (Denmark)

    Alexander, M S; Biering-Sørensen, F; Elliott, S

    2011-01-01

    To create the International Spinal Cord Injury (SCI) Male Sexual Function Basic Data Set within the International SCI Data Sets.......To create the International Spinal Cord Injury (SCI) Male Sexual Function Basic Data Set within the International SCI Data Sets....

  6. International spinal cord injury cardiovascular function basic data set

    DEFF Research Database (Denmark)

    Krassioukov, A; Alexander, M S; Karlsson, Anders Hans;

    2010-01-01

    To create an International Spinal Cord Injury (SCI) Cardiovascular Function Basic Data Set within the framework of the International SCI Data Sets.......To create an International Spinal Cord Injury (SCI) Cardiovascular Function Basic Data Set within the framework of the International SCI Data Sets....

  7. International Spinal Cord Injury Male Sexual Function Basic Data Set

    DEFF Research Database (Denmark)

    Alexander, M S; Biering-Sørensen, F; Elliott, S;

    2011-01-01

    To create the International Spinal Cord Injury (SCI) Male Sexual Function Basic Data Set within the International SCI Data Sets.......To create the International Spinal Cord Injury (SCI) Male Sexual Function Basic Data Set within the International SCI Data Sets....

  8. International spinal cord injury cardiovascular function basic data set

    DEFF Research Database (Denmark)

    Krassioukov, A; Alexander, M S; Karlsson, Anders Hans

    2010-01-01

    To create an International Spinal Cord Injury (SCI) Cardiovascular Function Basic Data Set within the framework of the International SCI Data Sets.......To create an International Spinal Cord Injury (SCI) Cardiovascular Function Basic Data Set within the framework of the International SCI Data Sets....

  9. Shriners Hospital Spinal Cord Injury Self Care Manual.

    Science.gov (United States)

    Fox, Carol

    This manual is intended for young people with spinal cord injuries who are receiving rehabilitation services within the Spinal Cord Injury Unit at Shriners Hospital (San Francisco, California). An introduction describes the rehabilitation program, which includes family conferences, an individualized program, an independent living program,…

  10. The Spinal Cord Injury-Interventions Classification System

    NARCIS (Netherlands)

    van Langeveld, A.H.B.

    2010-01-01

    Title: The Spinal Cord Injury-Interventions Classification System: development and evaluation of a documentation tool to record therapy to improve mobility and self-care in people with spinal cord injury. Background: Many rehabilitation researchers have emphasized the need to examine the actual cont

  11. The Spinal Cord Injury-Interventions Classification System

    NARCIS (Netherlands)

    van Langeveld, A.H.B.|info:eu-repo/dai/nl/304811416

    2010-01-01

    Title: The Spinal Cord Injury-Interventions Classification System: development and evaluation of a documentation tool to record therapy to improve mobility and self-care in people with spinal cord injury. Background: Many rehabilitation researchers have emphasized the need to examine the actual

  12. Thiopental dose requirements for induction of anaesthesia and subsequent endotracheal intubation in patients with complete spinal cord injuries.

    Science.gov (United States)

    Yoo, K Y; Jeong, C W; Jeong, H J; Lee, S H; Na, J H; Kim, S J; Jeong, S T; Lee, J

    2012-07-01

    Dose requirements of thiopental depend on patient characteristics and infusion rate. We determined thiopental dose requirements for induction of anaesthesia, and the effects of remifentanil on cardiovascular and bispectral index (BIS) responses to tracheal intubation in spinal cord-injured (SCI) patients undergoing general anaesthesia. Twenty patients with traumatic complete SCI undergoing elective surgery were enrolled. Twenty patients without SCI served as control. Anaesthesia was induced with thiopental, followed by remifentanil 1 μg/kg and rocuronium 0.8 mg/kg, and maintained with 2% sevoflurane and 50% nitrous oxide in oxygen after tracheal intubation. Thiopental was administered at a rate of 50 mg/15 s until abolition of the eyelash reflex. Thiopental doses, BIS values, systolic arterial blood pressure (SAP), heart rate (HR) and plasma catecholamine concentrations were measured. Total thiopental dose required to abolish the eyelash reflex based on total body weight (BW) (5.26 ± 0.87 vs. 3.91 ± 1.07 mg/kg, P intubation in both groups. However, the peak SAP after intubation was smaller in the SCI patients. HR increased significantly above baseline values following intubation in both groups with no significant intergroup differences. Hypertension was more frequent in the control group. Norepinephrine concentrations remained unaltered following intubation in both groups. These results suggest that the dose requirements of thiopental for induction of general anaesthesia and subsequent tracheal intubation are reduced in the SCI patients. © 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

  13. Neuroarthropathy of the hip following spinal cord injury

    Directory of Open Access Journals (Sweden)

    Bibek Banskota

    2011-01-01

    Full Text Available We present the case of a 33-year-old male who sustained a burst fracture D12 vertebrae with spinal cord injury (ASIA impairment scale A and a right mid-diaphysial femoral shaft fracture around 1.5 years back. The patient reported 1.5 years later with a swelling over the right buttock. Arthrotomy revealed serous fluid and fragmented bone debris. The biopsy showed a normal bony architecture with no evidence of infection and malignant cells. Hence, a diagnosis of Charcot′s hip was made. Charcot′s neuroarthropathy of the feet is a well-recognized entity in the setting of insensate feet resulting from causes such as diabetes or spina bifida. Although Charcot′s disease of the hips has been described, it is uncommon in association with spinal cord injury, syphilis and even with the use of epidural injection. The present case highlights the fact that neuroarthropathy of the hip can occur in isolation in the setting of a spinal cord injury, and this can lead to considerable morbidity.

  14. Spinal cord injury--scientific challenges for the unknown future.

    Science.gov (United States)

    Anderberg, Leif; Aldskogius, Håkan; Holtz, Anders

    2007-01-01

    The history of spinal cord injuries starts with the ancient Egyptian medical papyrus known as the Edwin Smith Surgical Papyrus. The papyrus written about 2500 B.C.by the physician and architect of the Sakkara pyramids Imhotep, describes "crushed vertebra in his neck" as well as symptoms of neurological deterioration. An ailment not to be treated was the massage to the patients at that time. This fatalistic attitude remained until the end of World War II when the first rehabilitation centre focused on the rehabilitation of spinal cord injured patients was opened. Our knowledge of the pathophysiological processes, both the primary as well as the secondary, has increased tremendously. However, all this knowledge has only led to improved medical care but not to any therapeutic method to restore, even partially, the neurological function. Neuroprotection is defined as measures to counteract secondary injury mechanisms and/or limit the extent of damage caused by self-destructive cellular and tissue processes. The co-existence of several distinctly different injury mechanisms after trauma has provided opportunities to explore a large number of potentially neuroprotective agents in animal experiments such as methylprednisolone sodium succinate. The results of this research have been very discouraging and pharmacological neuroprotection for patients with spinal cord injury has fallen short of the expectations created by the extensive research and promising observations in animal experiments. The focus of research has now, instead, been transformed to the field of neural regeneration. This field includes the discovery of regenerating obstacles in the nerve cell and/or environmental factors but also various regeneration strategies such as bridging the gap at the site of injury as well as transplantation of foetal tissue and stem cells. The purpose of this review is to highlight selected experimental and clinical studies that form the basis for undertaking future challenges in

  15. Epidemiology map of traumatic spinal cord injuries: A global overview

    Directory of Open Access Journals (Sweden)

    Angelo V. Vasiliadis

    2012-01-01

    Full Text Available Background: Traumatic spinal cord injury (TSCI represents a serious medical problem for society on all continents. This review provides the epidemiology of TSCI from 1978-2009. It explores the incidence,demography, aetiology of injury, secondary complications, length of stay and provides strategies for improved prevention.Aim: This study summarizes the available data about the epidemiological data of traumatic spinal cord injuries worldwide.Methods: A systematic review in PubMed was conducted.Results: The incidence rates varied greatly among continents. Most of patients with TSCI are young men between 20 to 30 years with road accidents as the leading cause of injury worldwide. The majority of studies reported a high incidence of injury in cervical region.Conclusions: There is a need for improved methods of registration of TSCI particularly from the lack of data from countries of Africa. To clarify regional differences, future epidemiological studies should carry out regional incidence. It is obvious the need for enforcement of laws and also for public awareness campaigns and education programmes.

  16. Extensive Spinal Cord Injury following Staphylococcus aureus Septicemia and Meningitis

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    Nicolas De Schryver

    2011-06-01

    Full Text Available Bacterial meningitis is rarely complicated by spinal cord involvement in adults. We report a case of Staphylococcus aureus septicemia complicated by meningitis and extensive spinal cord injury, leading to ascending brain stem necrosis and death. This complication was investigated by magnetic resonance imaging which demonstrated intramedullary hyperintensity on T2-weighted images and by multimodality evoked potentials. Postmortem microscopic examination confirmed that the extensive spinal cord injury was of ischemic origin, caused by diffuse leptomeningitis and endarteritis.

  17. Ambulation following spinal cord injury and its correlates

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    Nitin Menon

    2015-01-01

    Full Text Available Objectives: To assess walking ability of spinal cord injury (SCI patients and observe its correlation with functional and neurological outcomes. Patients and Methods: The present prospective, observational study was conducted in a tertiary research hospital in India with 66 patients (46 males between January 2012 and December 2013. Mean age was 32.62 ± 11.85 years (range 16-65 years, mean duration of injury was 85.3 ± 97.6 days (range 14-365 days and mean length of stay in the rehabilitation unit was 38.08 ± 21.66 days (range 14-97 days in the study. Walking Index for spinal cord injury (WISCI II was used to assess ambulation of the SCI patients. Functional recovery was assessed using Barthel Index (BI and Spinal Cord Independence Measures (SCIM. Neurological recovery was assessed using ASIA impairment scale (AIS. We tried to correlate ambulatory ability of the patients with functional and neurological recovery. Results: Ambulatory ability of the patients improved significantly using WISCI II (P < 0.001 when admission and discharge scores were compared (1.4 ± 3.5 vs 7.6 ± 6.03. Similarly, functional (BI: 31.7 ± 20.5 vs 58.4 ± 23.7 and SCIM: 29.9 ± 15.1 vs 56.2 ± 20.6 and neurological recovery were found to be very significant (P < 0.001 when admission vs discharge scores were compared. Improvement in WISCI II scores was significantly correlated with improvement in neurological (using AIS scores and functional status (using BI and SCIM scores (P < 0.001. Conclusions: Significant improvement was seen in WISCI II, BI, and SCIM scores after in-patient rehabilitation. Improvement in WISCI II scores also significantly correlated with functional and neurological recovery.

  18. Correlation of urinary lactic dehydrogenase with polymorphonuclear leukocytes in urinary tract infections in patients with spinal cord injuries.

    Science.gov (United States)

    Malik, G M; Canawati, H N; Keyser, A J; Ibrahim, M Z; Montgomerie, J Z

    1983-01-01

    A number of indirect methods have been developed to determine the site of urinary tract infection, including the measurement of LDH in urine [1]. Although LDH has been thought to be from the kidneys, it has also been noted that leukocytes could contribute LDH isoenzymes 4 and 5 [2]. Seventeen patients with injured spinal cords and significant bacteriuria were included in this study. Urine specimens obtained by urethral catheter were cultured, and PMNLs identified with Sternheimer-Malbin stain were counted in a hemacytometer. A positive test for antibody-coated bacteria and the lack of patient response to five to 10 days of antibiotic therapy were used as an indication of upper urinary tract infection. Levels of LDH isoenzymes 4 and 5 (cathodal) correlated with the number of PMNLs in the urine (r = 0.63, P less than 0.01). There was no correlation of PMNLs with LDH isoenzymes 1 and 2 (r = 0.18). In addition, there was no correlation of LDH isoenzymes 4 and 5 with the level of urinary tract infection. These results suggest that the PMNLs in the urine are the source of the LDH isoenzymes 4 and 5.

  19. Factors that influence on the confrontation the spinal cord injury

    Directory of Open Access Journals (Sweden)

    Montserrat Melchor Arteaga

    2011-05-01

    Full Text Available Definitions of spinal cord injury agree in the consequences of that injury is the loss in varying degrees of autonomic function; this will cause a change in the lifestyle of patients and their families.In the spinal injury, the priority is the recovery or maintenance of vital organ functions, the physical stabilization for people. Later, the priority here is the rehabilitation and adaptation. This should be integrated at all levels, physical, psychological and social. Confrontation is, by Callista Roy, a important variable for understanding the effect of stress on health and disease, health maintenance or recovery. The way, that the patients have to confront the disease, are the confrontation strategies. They are defined as thoughts and actions that persons put in place to deal with adverse changes. They are grouped into 3 categories: problems, emotions and avoidance.There are others factors that influence in the use of strategies, between them the personality. According to Eysenck this is determined by the functional interaction of four factors: cognitive (intelligence, conative (character, affective (temperament and somatic (construction. With this study we want to know the factors that influence in the confrontation of the spinal cord injury and to analyze the possible relation between them, and to be able to elaborate particular tools, on the most determinant factors, to obtain an effective confrontation about this type of disease.

  20. International Standards for Neurological Classification of Spinal Cord Injury:

    DEFF Research Database (Denmark)

    Kirshblum, S C; Biering-Sørensen, Fin; Betz, R

    2014-01-01

    The International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) is routinely used to determine levels of injury and to classify the severity of the injury. Questions are often posed to the International Standards Committee of the American Spinal Injury Association...

  1. Application of a model to analyze shoulder biomechanics in adult patients with spinal cord injury when walking with crutches in two different gait patterns.

    Science.gov (United States)

    Perez-Rizo, Enrique; Trincado-Alonso, Fernando; Pérez-Nombela, Soraya; Del Ama-Espinosa, Antonio; Jiménez-Díaz, Fernando; Lozano-Berrio, Vicente; Gil-Agudo, Angel

    2017-01-01

    Specific biomechanical models have been developed to study gait using crutches. Clinical application of these models is needed in adult spinal cord injury (SCI) population walking with different patterns of gait with crutches to prevent overuse shoulder injuries. To apply a biomechanical model in a clinical environment to analyze shoulder in adult SCI patients walking with two different patterns of gait with crutches: two point reciprocal gait (RG) and swing-through gait (SG). Load cells were fixed to the distal ends and forearm cuffs of a pair of crutches. An active markers system was used for kinematics. Five cycles for each gait pattern were analyzed applying a biomechanical model of the upper limbs. Fifteen subjects with SCI were analyzed. The flexo-extension range of motion was significantly greater when using SG (p forces were significantly stronger for SG in all 3 directions. Flexion, adduction and internal rotation torques were also greater in SG (p model was successfully applied to study shoulder biomechanics in adult patients with SCI walking with crutches in two different gait patterns. Greater loads exerted on the shoulder walking with SG were confirmed compared to RG.

  2. A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study

    NARCIS (Netherlands)

    Middendorp, J.J. van; Hosman, A.J.F.; Donders, A.R.T.; Pouw, M.H.; Ditunno Jr., J.F.; Curt, A.; Geurts, A.C.H.; Meent, H. van de

    2011-01-01

    BACKGROUND: Traumatic spinal cord injury is a serious disorder in which early prediction of ambulation is important to counsel patients and to plan rehabilitation. We developed a reliable, validated prediction rule to assess a patient's chances of walking independently after such injury. METHODS: We

  3. Restoration of Bladder and Bowel Function Using Electrical Stimulation and Block after Spinal Cord Injury

    Science.gov (United States)

    2015-10-01

    NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) VA Palo Alto Health Care System /PAVIR 3801 Miranda...records of 779 patients with spinal cord injury attending the Spinal Cord Injury Service of the VA Palo Alto Health Care System have been examined to...DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour per response

  4. Trigemino-cervical-spinal reflexes after traumatic spinal cord injury.

    Science.gov (United States)

    Nardone, Raffaele; Höller, Yvonne; Orioli, Andrea; Brigo, Francesco; Christova, Monica; Tezzon, Frediano; Golaszewski, Stefan; Trinka, Eugen

    2015-05-01

    After spinal cord injury (SCI) reorganization of spinal cord circuits occur both above and below the spinal lesion. These functional changes can be determined by assessing electrophysiological recording. We aimed at investigating the trigemino-cervical reflex (TCR) and trigemino-spinal reflex (TSR) responses after traumatic SCI. TCR and TSR were registered after stimulation of the infraorbital nerve from the sternocleidomastoid, splenius, deltoid, biceps and first dorsal interosseous muscles in 10 healthy subjects and 10 subjects with incomplete cervical SCI. In the control subjects reflex responses were registered from the sternocleidomastoid, and splenium muscles, while no responses were obtained from upper limb muscles. In contrast, smaller but clear short latency EMG potentials were recorded from deltoid and biceps muscles in about half of the SCI patients. Moreover, the amplitudes of the EMG responses in the neck muscles were significantly higher in patients than in control subjects. The reflex responses are likely to propagate up the brainstem and down the spinal cord along the reticulospinal tracts and the propriospinal system. Despite the loss of corticospinal axons, synaptic plasticity in pre-existing pathways and/or formation of new circuits through sprouting processes above the injury site may contribute to the findings of this preliminary study and may be involved in the functional recovery. Trigemino-cervical-spinal reflexes can be used to demonstrate and quantify plastic changes at brainstem and cervical level following SCI. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  5. Ludwig Guttmann: emerging concept of rehabilitation after spinal cord injury.

    Science.gov (United States)

    Schültke, E

    2001-12-01

    Ludwig Guttmann was a pioneer of the idea of rehabilitation for victims of spinal cord injury. He looked beyond the physical survival of his patients, to their re-integration into a social life worth living. While the International Stoke Mandeville Games are fairly well known to the general public as a gathering for physically handicapped athletes, less is known about the man who helped start the movement. On the occasion of the recent Sydney 2000 Paralympics, this paper reviews the contribution of Ludwig Guttmann, who introduced sport into the life of paralyzed patients.

  6. The cellular inflammatory response in human spinal cords after injury.

    Science.gov (United States)

    Fleming, Jennifer C; Norenberg, Michael D; Ramsay, David A; Dekaban, Gregory A; Marcillo, Alexander E; Saenz, Alvaro D; Pasquale-Styles, Melissa; Dietrich, W Dalton; Weaver, Lynne C

    2006-12-01

    Spinal cord injury (SCI) provokes an inflammatory response that generates substantial secondary damage within the cord but also may contribute to its repair. Anti-inflammatory treatment of human SCI and its timing must be based on knowledge of the types of cells participating in the inflammatory response, the time after injury when they appear and then decrease in number, and the nature of their actions. Using post-mortem spinal cords, we evaluated the time course and distribution of pathological change, infiltrating neutrophils, monocytes/macrophages and lymphocytes, and microglial activation in injured spinal cords from patients who were 'dead at the scene' or who survived for intervals up to 1 year after SCI. SCI caused zones of pathological change, including areas of inflammation and necrosis in the acute cases, and cystic cavities with longer survival (Zone 1), mantles of less severe change, including axonal swellings, inflammation and Wallerian degeneration (Zone 2) and histologically intact areas (Zone 3). Zone 1 areas increased in size with time after injury whereas the overall injury (size of the Zones 1 and 2 combined) remained relatively constant from the time (1-3 days) when damage was first visible. The distribution of inflammatory cells correlated well with the location of Zone 1, and sometimes of Zone 2. Neutrophils, visualized by their expression of human neutrophil alpha-defensins (defensin), entered the spinal cord by haemorrhage or extravasation, were most numerous 1-3 days after SCI, and were detectable for up to 10 days after SCI. Significant numbers of activated CD68-immunoreactive ramified microglia and a few monocytes/macrophages were in injured tissue within 1-3 days of SCI. Activated microglia, a few monocytes/macrophages and numerous phagocytic macrophages were present for weeks to months after SCI. A few CD8(+) lymphocytes were in the injured cords throughout the sampling intervals. Expression by the inflammatory cells of the oxidative

  7. Prediction of isometric motor tasks and effort levels based on high-density EMG in patients with incomplete spinal cord injury

    Science.gov (United States)

    Jordanić, Mislav; Rojas-Martínez, Mónica; Mañanas, Miguel Angel; Francesc Alonso, Joan

    2016-08-01

    Objective. The development of modern assistive and rehabilitation devices requires reliable and easy-to-use methods to extract neural information for control of devices. Group-specific pattern recognition identifiers are influenced by inter-subject variability. Based on high-density EMG (HD-EMG) maps, our research group has already shown that inter-subject muscle activation patterns exist in a population of healthy subjects. The aim of this paper is to analyze muscle activation patterns associated with four tasks (flexion/extension of the elbow, and supination/pronation of the forearm) at three different effort levels in a group of patients with incomplete Spinal Cord Injury (iSCI). Approach. Muscle activation patterns were evaluated by the automatic identification of these four isometric tasks along with the identification of levels of voluntary contractions. Two types of classifiers were considered in the identification: linear discriminant analysis and support vector machine. Main results. Results show that performance of classification increases when combining features extracted from intensity and spatial information of HD-EMG maps (accuracy = 97.5%). Moreover, when compared to a population with injuries at different levels, a lower variability between activation maps was obtained within a group of patients with similar injury suggesting stronger task-specific and effort-level-specific co-activation patterns, which enable better prediction results. Significance. Despite the challenge of identifying both the four tasks and the three effort levels in patients with iSCI, promising results were obtained which support the use of HD-EMG features for providing useful information regarding motion and force intention.

  8. Role of taurine in spinal cord injury.

    Science.gov (United States)

    Gupta, R C; Seki, Y; Yosida, J

    2006-08-01

    Taurine is a sulfur amino acid. It is found endogenously in human and several others tissues. It is significantly in high concentration in mammals. Human body contains about 0.1% of body weight as taurine. It has a number of physiological and pharmacological actions. It is also used in the therapy of important organs dysfunctions. In spinal cord it has inhibitory effects; like antiepileptic and anti-nociceptive. Taurine also inhibits substance p induced biting and scratching behavior. In spinal cord injury elevated level of taurine has been observed. Higher level of taurine has been also recorded in SCI therapy using, known clinical agent methyl prednisolone (MP). The increased taurine concentration seems to be involved in protection and regeneration of tissues following injury. In SCI along with physical injury secondary activities also takes place which are complex in nature. Secondary activity includes vascular events and activation of neutrophils, resulting endothelial damage. Activated neutrophils; release a variety of inflammatory mediators such as myeloperoxidase (MPO), reactive oxygen species (ROS), and some others. It is believed that taurine exert its protective action through scavenging of ROS and down regulating several other inflammatory mediators like tumor necrosis factors (TNFalpha). The inside of mechanism reveals toxic substance HOCl is produced by MPO is converted to less toxic substances through scavenging action of taurine. Amino acid therapy has its own limitations and to over come such situation there is a need to develop small, simple lipophilic analogs of taurine. Use of taurine analogs has provided better results; for example, N- chloro taurine (NCT) which is a taurine derivative has exhibited therapeutic advances over taurine. Taurine and its analogs with sound experimental and clinical support may constitute a new class of therapeutic agents for SCI., and perhaps this review may provide enough material to think of this.

  9. Correlation of force control with regional spinal DTI in patients with cervical spondylosis without signs of spinal cord injury on conventional MRI

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    Lindberg, Paavel G. [Universite Paris Descartes, Sorbonne Paris Cite, FR 3636 Neurosciences, Paris (France); Centre de Psychiatrie et Neurosciences, Inserm U894, Paris (France); Universite Paris Descartes, Sorbonne Paris Cite, Paris (France); Universite Paris Descartes, Service de Radiologie B, APHP, CHU Cochin, Faculte de Medecine, Paris (France); Sanchez, Katherine; Rannou, Francois; Poiraudeau, Serge [Universite Paris Descartes, Sorbonne Paris Cite, Paris (France); Service de Medecine Physique et de Readaptation, APHP, CHU Cochin, Paris (France); INSERM U1153 Epidemiologie Clinique des Maladies Osteo-Articulaires, Paris (France); Ozcan, Fidan [Universite Paris Descartes, Sorbonne Paris Cite, FR 3636 Neurosciences, Paris (France); Feydy, Antoine [Universite Paris Descartes, Sorbonne Paris Cite, FR 3636 Neurosciences, Paris (France); Universite Paris Descartes, Sorbonne Paris Cite, Paris (France); Universite Paris Descartes, Service de Radiologie B, APHP, CHU Cochin, Faculte de Medecine, Paris (France); Maier, Marc A. [Universite Paris Descartes, Sorbonne Paris Cite, FR 3636 Neurosciences, Paris (France); Universite Paris Descartes, Sorbonne Paris Cite, Paris (France); Universite Paris Diderot, Sorbonne Paris Cite, Paris (France)

    2016-03-15

    The aim of this study was to investigate spinal cord structure in patients with cervical spondylosis where conventional MRI fails to reveal spinal cord damage. We performed a cross-sectional study of patients with cervical spondylosis without conventional MRI findings of spinal cord damage and healthy controls. Subjects were studied using spinal diffusion tensor imaging (DTI), precision grip and foot force-tracking tasks, and a clinical examination including assessment of neurological signs. A regional analysis of lateral and medial spinal white matter across multiple cervical levels (C1-C5) was performed. DTI revealed reduced fractional anisotropy (FA) and increased radial diffusivity (RD) in the lateral spinal cord at the level of greatest compression (lowest Pavlov ratio) in patients (p < 0.05). Patients with spondylosis had greater error and longer release duration in both grip and foot force-tracking. Similar spinal cord deficits were present in patients without neurological signs. Increased error in grip and foot tracking (low accuracy) correlated with increased RD in the lateral spinal cord at the level of greatest compression (p ≤ 0.01). Spinal DTI can detect subtle spinal cord damage of functional relevance in cervical spondylosis, even in patients without signs on conventional T2-imaging and without neurological signs. (orig.)

  10. Spinal cord injury from fluoroscopically guided intercostal blocks with phenol.

    Science.gov (United States)

    Kissoon, Narayan R; Graff-Radford, Jonathan; Watson, James C; Laughin, Ruple S

    2014-01-01

    Image guided intercostal blocks are commonly performed and considered relatively safe. Chemical denervation is commonly used in clinical practice for treatment of chronic non-cancer associated pain. To report a case of spinal cord injury resulting from fluoroscopically guided intercostal blocks with phenol. Case report. Inpatient hospital service. RESULTS/CASE REPORTS: A 53 year-old women was transferred from her local facility for acute onset of lower extremity paresis beginning shortly after right intercostal nerve injections of 2 mL of preservative-free phenol at the T7, 8, 9 levels. She had previous intercostal blocks for chronic right-sided mid thoracic/abdominal pain every 3 months for at least one year without sequelae. Within 20 minutes of the injection, she developed a sensation of right leg weakness and heaviness. Over several hours she developed worsening right leg weakness, and then left leg weakness, followed by urinary retention. Admission examination revealed severe right greater than left leg weakness, right lower extremity hyperesthesia to T10, absent lower extremity reflexes, and bilateral extensor plantar responses. Magnetic resonance imaging (MRI) of the entire spine demonstrated extensive T2/DWI hyperintensity in the central spinal cord from T1 to L1 with mild cord enlargement and enhancement at T7-9 (sites of injection). Extensive serum and cerebrospinal fluid (CSF) evaluation did not show any evidence of an infectious, inflammatory, or metabolic cause to her myelopathy. Repeat MRI of the entire spine demonstrated near complete resolution of the T2 signal abnormality. One month after presentation, despite radiographic improvement, the patient showed some clinical improvement, but remained walker dependent and with neurogenic bowel and bladder. This report describes a single case report. This case offers several lessons for a pain specialist including 1) the potential for a neurologic catastrophe (spinal cord injury) from aqueous neurolytic

  11. Effects of modified constraint-induced movement therapy and functional bimanual training on upper extremity function and daily activities in a patient with incomplete spinal cord injury: a case study.

    Science.gov (United States)

    Kim, Yeon-Ju; Kim, Jin-Kyung; Park, So-Yeon

    2015-12-01

    [Purpose] In this study, we examined effects of modified constraint-induced movement therapy (m-CIMT) and functional bimanual training, when applied to a patient with incomplete spinal cord injury, on upper extremity function and daily activities. [Subject and Methods] One patient, diagnosed with C4 incomplete spinal cord injury, underwent physical therapy with constraint-induced movement therapy for 3 hours and task-oriented bimanual training for 1 hour, per day. This combined 4-hour session was performed five times a week, for 3 weeks, totaling 15 sessions. Upper extremity function was measured using the Manual Function Test (MFT) and Box & Block Test (BBT). Additionally, Spinal Cord Independence Measure Version III (SCIM-III) and Short Form 36 Health Survey (SF-36) were used to assess functional outcomes. [Results] Mobility of the hand and overall function of upper extremities were enhanced following intervention. Moreover, the subject's quality of life and ability to carry out daily activities also improved. [Conclusion] Modified constraint-induced movement therapy and bimanual training was effective in enhancing upper extremity function and performance of daily routines in a patient with incomplete spinal cord injury. Further studies, recruiting multiple subjects, should focus on m-CIMT using diverse methods, performed during the course of daily activities.

  12. Use of an arm weight-bearing combined with upper-limb reaching apparatus to facilitate motor paralysis recovery in an incomplete spinal cord injury patient: a single case report

    Science.gov (United States)

    Hoei, Takashi; Kawahira, Kazumi; Fukuda, Hidefumi; Sihgenobu, Keizo; Shimodozono, Megumi; Ogura, Tadashi

    2017-01-01

    [Purpose] Training using an arm weight-bearing device combined with upper-limb reaching apparatus to facilitate motor paralysis recovery, named the “Reaching Robot”, as well as Repetitive Facilitation Exercise were applied to a patient with severe impairment of the shoulder and elbow due to incomplete spinal cord injury and the effects were examined. [Subjects and Methods] A 66-year-old man with incomplete spinal cord injury participated in an upper extremity rehabilitation program involving a Reaching Robot. The program was comprised of active motor suspension, continuous low amplitude neuromuscular electrical stimulation and functional vibratory stimulation, as well as Repetitive Facilitation Exercise combined with continuous low amplitude neuromuscular electrical stimulation. This protocol used a crossover design following an A1-B1-A2-B2. “A” consisted of 2 weeks of Repetitive Facilitation Exercise, and “B” consisted of 2 weeks of Reaching Robot training. [Results] Improvements were observed after all sessions. Active range of motion for shoulder flexion improved after 2 weeks of Reaching Robot sessions only. There were no adverse events. [Conclusion] Reaching Robot training for severe paretic upper-extremity after incomplete spinal cord injury was a safe and effective treatment. Reaching Robot training may be useful for rehabilitation of paretic upper-extremity after incomplete spinal cord injury. PMID:28210068

  13. Application of International Classification of Functioning, Disability and Health (ICF in individuals with spinal cord injury

    Directory of Open Access Journals (Sweden)

    Janaina Vall

    2011-06-01

    Full Text Available After spinal cord injury is common functionality is affected. OBJECTIVE: To evaluate the functionality of patients with spinal cord injury. METHOD: Cross-sectional study by means of the International Classification of Functionality (ICF. 109 adults with spinal cord injury in the city of Curitiba, Brazil were evaluated. RESULTS: The categories most compromised in body were intestines and bladder, sexuality, energy, sleep, emotion and weight. In the domain activities and participation, there was greater difficulty in tasks of bathing, toilet and dressing, self care and leisure. In the domain environmental factors, the categories classified as facilitators were: medications, orthoses and wheelchair, attitude of family, transport, social foresight and health services. The categories classified as barriers were: attitude of authorities, social attitudes, education and work. CONCLUSION: The application of the ICF in persons with spinal cord injury demonstrated a series of disabilities and limitations.

  14. AB204. Repeated intradetrusor botulinum toxin type A injections are still effective for patients with neurogenic detrusor overactivity secondary to spinal cord injury in China

    Science.gov (United States)

    Chen, Hui; Yang, Xinghua; Zeng, Jingwen; Huang, Maping; Liu, Qiuling; Huang, Jiebing; Huang, Tianhai; Xie, Keji; Jiang, Chonghe

    2016-01-01

    Objective To assess effective outcomes following repeated treatment with intradetrusor botulinum toxin type A in patients with neurogenic detrusor overactivity (NDO). Methods Patients with NDO secondary to spinal cord injury (SCI) were enrolled. Botulinum toxin type A 200 U detrusor injections by a rigid cystoscope were repeated. Primary outcomes were urodynamic variables including maximum detrusor pressure during first involuntary detrusor contraction (Pdetmax IDC) filling cystometry, detrusor compliance (DC). Secondary outcomes were improvement of the patient’s quality of life (QoL) measured by Incontinence-Specific Quality-of-Life Instrument (I-QoL), the validated short forms of Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Related adverse events were recorded. Results From 2012 to 2014, 159 injections were performed in 52 patients (44 male, 8 female). The mean age was 36.67 years. The maximum number of repeated injections was five. BC increased from (4.03–7.45) to (6.96–10.86) mL/cmH2O, Pdetmax in bladder storage decreased from (42.80–79.52) to (26.40–43.33) cmH2O, respectively. The I-QoL, UDI-6 and IIQ-7 showed a consistent improvement after repeated injections. Conclusions Repeated intradetrusor botulinum toxin type A injections remain improve QoL in patients with NDO secondary to SCI.

  15. Implanted electro-acupuncture electric stimulation improves outcome of stem cells' transplantation in spinal cord injury.

    Science.gov (United States)

    Liu, Haichun; Yang, Kaiyun; Xin, Tao; Wu, Wenliang; Chen, Yunzhen

    2012-10-01

    Spinal cord injury (SCI) is one of the most serious disorders in clinics, and the high disability rate and functional deficits are common issues in patients. Transplantation of bone-marrow-derived mesenchymal stromal cells (BMSCs) into the injured spinal cord is emerging as a novel method in the therapeutics of SCI; however, its application is limited by the poor survival rate of the transplanted cells and low differentiation rate into neurons. Our laboratory recently reported that electrical stimulation (ES) dramatically improves the survival rate of transplanted BMSCs and increases spinal cord functions in animals with spinal cord injury. In this paper, we asked whether implanted electro-acupuncture (iEA) can advance the beneficial effects from the ES treatment in animals with spinal cord injury. We showed that BMSCs transplantation alone resulted in significant functional recovery in animals. Interestingly, iEA with BMSCs treatment induced a significantly higher functional improvement in locomotor functions and SSEP compared to the BMSCs treatment alone. Additionally, we used molecular biology techniques and showed that BMSCs transplantation with iEA treatment significantly increased the number of surviving BMSCs compared to the BMSCs alone group. In conclusion, our experiment showed that the approach of coupling iEA electric stimulation and BMSCs transplantation remarkably promotes functional improvements in animals with spinal cord injury and holds promising potential to treat spinal cord injury in humans.

  16. Spinal cord injury of cervical vertibrae and early diagnosis and treatment

    Institute of Scientific and Technical Information of China (English)

    陈扬; 李振宇; 等

    1999-01-01

    Objective:To sum up clinical data and CT and MRI examination in 22 patients with spinal cord injury of cervical vertebrae.Methods:CT and MRI examination of the 22 patients with spinal cord injury of cervical vertebrae revealed that 16 patients had spinal comprssion caused by fracture dislocation and protrusion of intervertebral disc,5 suffered from intramedullary hemorrhage and 1 had complete spinal cord injury.A combined modality therapy of intramedullary and extramedullary decompression for spinal cord,skull traction and avoiding reinjury to spinal cord were used. Results:According to Frankel Classification,before operation 3 cases were classified as A degree,2 as B degree,5as C degree,8 as D degree and 4 as Edegree;after operation 2 were classified as A degree,1 as B degree,6 as C degree,6 as D degree and 7 as E degree.Conclusions:Early diagnosis and timely treatmetn,clear mechanism and degree of injury and early selection of effective treatment are very important in raising the rate of curing spinal cord injury.

  17. Follow-up CT myelography of severe cervical spinal cord injury

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Keiichi; Onoda, Kimio; Kawashima, Yasuhiro; Muto, Atsushi; Kobayashi, Yoichi

    1987-11-01

    There are many reports describing gross anatomical and microscopical findings of severely injured cervical cords in autopsy of the acute and chronic state, but no morphological findings of a severe cervical spinal cord injury in a chronic state by follow-up CT myelography have been found in the literature so far. The sagittal and transverse diameters of the cervical spinal cord and subarachnoid space of 9 out of 14 severe cervical spinal cord injury patients were measured with CT myelography within 7.5 years after the tranuma and their size compared with a control group which was made up of 29 patients with slight radiculopathy due to cervical spondylosis and whiplash injuries. Injured cord levels were C4 4 cases, C5 4 cases and C6 1 case. Remarkable spinal cord atrophy was recogniged in the sagittal diameter from C1 to C7 and in the transverse diameter below C4 and narrowing of the cervical subarachnoid space in the sagittal diameter from C2 to C5. The significance level was set at 1 - 5 %. From these fingings, we have concluded that atrophy appeared not only in the injured segment but also the whole cervical cord after the trauma. There was less cord atrophy in a good functional prognosis than in a poor prognosis.

  18. Epidural spinal cord stimulation for recovery from spinal cord injury: its place in therapy

    Directory of Open Access Journals (Sweden)

    Jacques L

    2016-09-01

    Full Text Available Line Jacques, Michael Safaee Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA Abstract: This paper is a review of some of the current research focused on using existing epidural spinal cord stimulation technologies in establishing the effectiveness in the recovery of independent standing, ambulation, or intentional movement of spinal cord injury patients. From a clinician’s perspective, the results have been intriguing, from a restorative perspective they are promising, and from a patient’s perspective they are hopeful. The outcomes, although still in the experimental phase, show some proof of theory and support further research. From a high volume university based clinician’s perspective, the resources needed to integrate this type of restorative care into a busy clinical practice are highly challenging without a well-structured and resource rich institutional restorative program. Patient selection is profoundly critical due to the extraordinary resources needed, and the level of motivation required to participate in such an intense and arduous rehabilitation process. Establishing an algorithmic approach to patient selection and treatment will be paramount to effectively utilize scarce resources and optimize outcomes. Further research is warranted, and the development of dedicated technological hardware and software for this therapeutic treatment versus using traditional spinal cord stimulation devices may yield more robust and efficacious outcomes. Keywords: independent standing, ambulation, intentional movement, recovery, rehabilitation, locomotion

  19. Race-Ethnicity, Education, and Employment after Spinal Cord Injury

    Science.gov (United States)

    Krause, James S.; Saunders, Lee; Staten, David

    2010-01-01

    The objective of this article was to identify the relationship between race-ethnicity and employment after spinal cord injury (SCI), while evaluating interrelationships with gender, injury severity, and education. The authors used a cohort design using the most current status from a post-injury interview from the National SCI Statistical Center.…

  20. Race-Ethnicity, Education, and Employment after Spinal Cord Injury

    Science.gov (United States)

    Krause, James S.; Saunders, Lee; Staten, David

    2010-01-01

    The objective of this article was to identify the relationship between race-ethnicity and employment after spinal cord injury (SCI), while evaluating interrelationships with gender, injury severity, and education. The authors used a cohort design using the most current status from a post-injury interview from the National SCI Statistical Center.…

  1. Hyperoxaluria, Hypocitraturia, Hypomagnesiuria, and Lack of Intestinal Colonization by Oxalobacter formigenes in a Cervical Spinal Cord Injury Patient with Suprapubic Cystostomy, Short Bowel, and Nephrolithiasis

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2006-01-01

    Full Text Available Although urolithiasis is common in spinal cord injury patients, it is presumed that the predisposing factors for urinary stones in spinal cord injury patients are immobilization-induced hypercalciuria in the initial period after spinal injury and, in later stages, urine infection by urease-producing micro-organisms, e.g., Proteus sp., which cause struvite stones. We describe a patient who sustained C-7 complete tetraplegia in a road traffic accident in 1970, when he was 16 years old. Left ureterolithotomy was performed in 1971 followed by left nephrectomy in 1972. Probably due to adhesions, this patient developed volvulus of the intestine in 1974. As he had complete tetraplegia, he did not feel pain in the abdomen and there was a delay in the diagnosis of volvulus, which led to ischemia of a large segment of the small bowel. All but 1 ft of jejunum and 1 ft of ileum were resected leaving the large bowel intact. In 1998, suprapubic cystostomy was performed. In 2004, this patient developed calculus in the solitary right kidney. Complete stone clearance was achieved by extracorporeal shock wave lithotripsy. Stone analysis: calcium oxalate 60% and calcium phosphate 40%. Metabolic evaluation revealed hyperoxaluria, hypocitraturia, and hypomagnesiuria. Since this patient had hyperoxaluria, the stool was tested for Oxalobacter formigenes, a specific oxalate-degrading, anerobic bacterium inhabiting the gastrointestinal tracts of humans; absence of this bacterium appears to be a risk factor for development of hyperoxaluria and, subsequently, calcium oxalate kidney stone disease. DNA from the stool was extracted using the QIAamp DNA stool Mini Kit (Qiagen, Chatsworth, CA. The genomic DNA was amplified by polymerase chain reaction using specific primers for oxc gene (developed by Sidhu and associates. The stool sample tested negative for O. formigenes. The patient was prescribed potassium citrate mixture; he was advised to avoid oxalate-rich food, maintain

  2. Mortality and morbidity after high-dose methylprednisolone treatment in patients with acute cervical spinal cord injury: a propensity-matched analysis using a nationwide administrative database.

    Science.gov (United States)

    Chikuda, Hirotaka; Yasunaga, Hideo; Takeshita, Katsushi; Horiguchi, Hiromasa; Kawaguchi, Hiroshi; Ohe, Kazuhiko; Fushimi, Kiyohide; Tanaka, Sakae

    2014-03-01

    To examine the magnitude of the adverse impact of high-dose methylprednisolone treatment in patients with acute cervical spinal cord injury (SCI). We examined the abstracted data from the Japanese Diagnosis Procedure Combination database, and included patients with ICD-10 code S141 who were admitted on an emergency basis between 1 July and 31 December in 2007-2009. The investigation evaluated the patients' sex, age, comorbidities, Japan Coma Scale, hospital volume and the amount of methylprednisolone administered. One-to-one propensity-score matching between high-dose methylprednisolone group (>5000 mg) and control group was performed to compare the rates of in-hospital death and major complications (sepsis; pneumonia; urinary tract infection; gastrointestinal ulcer/bleeding; and pulmonary embolism). We identified 3508 cervical SCI patients (2652 men and 856 women; mean age, 60.8 ± 18.7 years) including 824 (23.5%) patients who received high-dose methylprednisolone. A propensity-matched analysis with 824 pairs of patients showed a significant increase in the occurrence of gastrointestinal ulcer/bleeding (68/812 vs 31/812; prisk of complications (144/812 vs 96/812;OR, 1.66; 95% CI 1.23 to 2.24; p=0.001) than the control group. There was no significant difference in in-hospital mortality between the high-dose methylprednisolone group and the control group (p=0.884). Patients receiving high-dose methylprednisolone had a significantly increased risk of major complications, in particular, gastrointestinal ulcer/bleeding. However, high-dose methylprednisolone treatment was not associated with any increase in mortality.

  3. Cannabis use in persons with traumatic spinal cord injury in Denmark.

    Science.gov (United States)

    Andresen, Sven R; Biering-Sørensen, Fin; Hagen, Ellen Merete; Nielsen, Jørgen F; Bach, Flemming W; Finnerup, Nanna B

    2017-01-31

    To evaluate recreational and medical cannabis use in individuals with traumatic spinal cord injury, including reasons and predictors for use, perceived benefits and negative consequences. Cross-sectional survey in Denmark. A 35-item questionnaire was sent to 1,101 patients with spinal cord injury who had been in contact with a rehabilitation centre between 1990 and 2012. A total of 537 participants completed the questionnaire. Of these, 36% had tried cannabis at least once and 9% were current users. Of current users, 79% had started to use cannabis before their spinal cord injury. The main reason for use was pleasure, but 65% used cannabis partly for spinal cord injury-related consequences and 59% reported at least good effect on pain and spasticity. Negative consequences of use were primarily inertia and feeling quiet/subdued. Lower age, living in rural areas/larger cities, tobacco-smoking, high alcohol intake and higher muscle stiffness were significantly associated with cannabis use. Those who had never tried cannabis reported that they would mainly use cannabis to alleviate pain and spasticity if it were legalized. Cannabis use is more frequent among individuals with spinal cord injury in Denmark than among the general population. High muscle stiffness and various demographic characteristics (lower age, living in rural areas/larger cities, tobacco-smoking and high alcohol intake) were associated with cannabis use. Most participants had started using cannabis before their spinal cord injury. There was considerable overlap between recreational and disability-related use.

  4. Neuroprotection and its molecular mechanism following spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    Nai-Kui Liu; Xiao-Ming Xu

    2012-01-01

    Acute spinal cord injury initiates a complex cascade of molecular events termed 'secondary injury', which leads to progressive degeneration ranging from early neuronal apoptosis at the lesion site to delayed degeneration of intact white matter tracts, and, ultimately, expansion of the initial injury. These secondary injury processes include, but are not limited to, inflammation, free radical-induced cell death, glutamate excitotoxicity, phospholipase A2 activation, and induction of extrinsic and intrinsic apoptotic pathways, which are important targets in developing neuroprotective strategies for treatment of spinal cord injury. Recently, a number of studies have shown promising results on neuroprotection and recovery of function in rodent models of spinal cord injury using treatments that target secondary injury processes including inflammation, phospholipase A2 activation, and manipulation of the PTEN-Akt/mTOR signaling pathway. The present review outlines our ongoing research on the molecular mechanisms of neuroprotection in experimental spinal cord injury and briefly summarizes our earlier findings on the therapeutic potential of pharmacological treatments in spinal cord injury.

  5. The effect of semiconditional dorsal penile nerve electrical stimulation on capacity and compliance of the bladder with deformity in spinal cord injury patients: a pilot study.

    Science.gov (United States)

    Lee, Y-H; Kim, S-H; Kim, J M; Im, H T; Choi, I S; Lee, K W

    2012-04-01

    Bladder capacity, bladder compliance, the volume of the first overactive contraction, maximal volume during cystometry (CMG) and the vesicoureteral reflux, bladder wall deformity before and after semiconditional stimulation on DPN. To evaluate the effect of the semiconditional electrical stimulation on dorsal penile nerve (DPN) to improve the complicated bladder function in male with spinal cord injury (SCI). Semiconditional stimulation system and urodynamic laboratory in a university hospital. Six men (age, 33-59 years) with SCI incurred from 38 to 156 months before this study. semiconditional stimulation parameters were set during CMG and semiconditional stimulation on DPN by surface electrodes via Empi Focus stimulator was applied from 14 to 28 days, at home. Parameters about bladder function were measured before and after stimulation applied. All parameters for bladder after semiconditional stimulation were increased. Also, the vesicoureteral reflux and bladder wall deformity was improved in five of six patients. Semiconditional electrical stimulation on DPN effectively suppresses neurogenic detrusor overactivity and distend the bladder physiologically in the SCI patient with a complicated bladder. The bladder capacity and compliance as well as the bladder wall deformity were improved as a result of this treatment.

  6. Finding the optimal setting of inflated air pressure for a multi-cell air cushion for wheelchair patients with spinal cord injury.

    Directory of Open Access Journals (Sweden)

    Hamanami K

    2004-02-01

    Full Text Available Pressure distribution patterns of the seating interface on the multi-cell air cushion (ROHO High Profile of 36 adults with spinal cord injury (SCI (Neurological level Th3 -L1 were measured at different air pressure levels by a pressure mat measurement system. Stress distribution relative to the inflated air pressure in the air cushion on the patients' wheelchairs was analyzed to determine the appropriate inflated air pressure of the cushion for patients. The maximum pressure points in all subjects were at the areas of the ischial tuberosities (82 to 347 mmHg. The optimal reduction in interface pressure at the ischial tuberosities was obtained just before bottoming out. The cushion air pressure at that point was between 17 and 42 mmHg, and correlated well to body weight (r = 0.495, P = 0.0021. In contrast, the maximum pressure levels did not correlate to body weight or the Body Mass Index (BMI. Pressure at the ischial area could be reduced, but not eliminated, by adjusting the air pressure. The maximum pressure levels seemed to be related to the shape of the buttocks, especially the amount of soft tissue, and exceeded the defined threshold for pressure ulcers (> 80 g/cm2.

  7. A Lactobacillus casei Shirota probiotic drink reduces antibiotic-associated diarrhoea in patients with spinal cord injuries: a randomised controlled trial.

    Science.gov (United States)

    Wong, Samford; Jamous, Ali; O'Driscoll, Jean; Sekhar, Ravi; Weldon, Mike; Yau, Chi Y; Hirani, Shashivadan P; Grimble, George; Forbes, Alastair

    2014-02-01

    Certain probiotics may prevent the development of antibiotic-associated diarrhoea (AAD) and Clostridium difficile-associated diarrhoea (CDAD), but their effectiveness depends on both strain and dose. There are few data on nutritional interventions to control AAD/CDAD in the spinal cord injury (SCI) population. The present study aimed to assess (1) the efficacy of consuming a commercially produced probiotic containing at least 6·5 × 10⁹ live Lactobacillus casei Shirota (LcS) in reducing the incidence of AAD/CDAD, and (2) whether undernutrition and proton pump inhibitors (PPI) are risk factors for AAD/CDAD. A total of 164 SCI patients (50·1 (sd 17·8) years) with a requirement for antibiotics (median 21 d, range 5-366) were randomly allocated to receive LcS (n 76) or no probiotic (n 82). LcS was given once daily for the duration of the antibiotic course and continued for 7 days thereafter. Nutritional risk was assessed by the Spinal Nutrition Screening Tool. The LcS group had a significantly lower incidence of AAD (17·1 v. 54·9%, Pprobiotic (OR 8·46, 95% CI 3·22, 22·20) as the independent risk factors for AAD. The present study indicated that LcS could reduce the incidence of AAD in hospitalised SCI patients. A randomised, placebo-controlled study is needed to confirm this apparent therapeutic success in order to translate into improved clinical outcomes.

  8. Determinants of gait performance following spinal cord injury.

    Science.gov (United States)

    Waters, R L; Yakura, J S; Adkins, R; Barnes, G

    1989-11-01

    Measurement of lower extremity muscle strength and the energy expenditure during walking was taken in 36 spinal cord injury patients to assess functional mobility. Patients were categorized according to the type of orthotic prescription (knee-ankle-foot orthosis [KAFO] or ankle-foot orthosis [AFO]) or upper extremity assistive device (cane, crutches, or walker) used during gait. The rates of O2 consumption per minute, O2 cost per meter, heart rate, respiratory quotient, velocity, cadence, and peak axial load exerted by the arms on upper extremity assistive devices were measured. The Ambulatory Motor Index (AMI), derived from the manual muscle grades of both lower limbs, was used as the indicator of the degree of paralysis. The AMI was strongly correlated with the percentage increase in the rate of O2 consumption above normal (p less than .0001), O2 cost per meter (p less than .0001), peak axial load (p less than .0001), velocity (p less than .0001), and cadence (p less than .0001). Differences in these parameters among patient groups categorized according to the type of orthotic prescription (no KAFO, one KAFO, two KAFOs) or upper extremity assistive device (no device, cane or one crutch, two crutches, or walker) were attributable to differences in the AMI. The AMI, therefore, could be used as a reliable clinical indicator of functional mobility after spinal cord injury.

  9. Seminoma of Testis Masquerading as Orchitis in an Adult with Paraplegia: Proposed Measures to Avoid Delay in Diagnosing Testicular Tumours in Spinal Cord Injury Patients

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2008-01-01

    Full Text Available Orchitis is common in adult male spinal cord injury (SCI patients and, therefore, both health professionals and SCI patients themselves tend to attribute testicular swelling to orchitis, with a consequent potential delay in the diagnosis of testicular tumours. A 37-year-old man with paraplegia developed swelling of the right testis. With a presumptive diagnosis of acute bacterial orchitis, he was prescribed ciprofloxacin while awaiting an ultrasound scan. Ultrasound examination of the testis 4 weeks later showed a moderate hydrocele, enlargement and altered echogenicity of both the epididymis and testis, and features of mass-like lesions within the substance of the testis. As these changes might merely have represented a partly treated infection, a follow-up scan was carried out 2 weeks later, which revealed a lobulated mass of mixed echogenicity within the testis and a focal area of increased echogenicity indicative of calcification. A radical orchidectomy performed 19 days later revealed a seminoma. To prevent delay in the diagnosis of testicular tumours in SCI patients, we propose the following measures: (1 patients who develop swelling of the testis should consult a physician as soon as possible for clinical examination; blind antibiotic therapy should be avoided if possible; (2 if clinical examination reveals a hard swelling of the testis and the typical features of acute urinary infection are absent, an ultrasound scan of the scrotum should be performed as soon as possible; (3 in patients with equivocal ultrasound findings, ultrasound-guided, fine-needle aspiration cytology may allow an early diagnosis of testicular malignancy; (4 education of SCI patients and their caregivers is needed to implement these recommendations.

  10. Protocol of a prospective cohort study of the effect of different methods of drainage of neuropathic bladder on occurrence of symptomatic urinary infection, and adverse events related to the urinary drainage system in spinal cord injury patients

    Directory of Open Access Journals (Sweden)

    Oo Tun

    2001-11-01

    Full Text Available Abstract Background To present a protocol of a prospective, cohort study in which four groups of spinal cord injury (SCI patients will participate. (Patients with indwelling urethral catheter; patients who perform intermittent catheterisation without wearing a penile sheath; patients who perform intermittent catheterisation and wear penile sheath as well; and patients with penile sheath drainage. Objectives (1 What is the incidence of symptomatic urinary infection in men with spinal cord injury who use different types of bladder drainage? (2 Which are predisposing factors for the occurrence of symptomatic urinary infection in men with spinal cord injury who practise different methods of bladder drainage? (3 What is the incidence of catheter and urinary drainage system-related adverse events in the four groups of SCI patients? Patients The criteria for inclusion are as follow: (1 Male patients with neuropathic bladder due to spinal cord injury, who are registered with the Regional Spinal Injuries Centre, Southport, England. (2 Age: 18 years or above. (3 Patients who are willing to give informed consent for participation in the study. (4 Patients willing to be contacted every two weeks by a staff of the spinal unit for 36 months. (5 Patients who are willing to maintain an accurate record of adverse events related to urinary catheter and urinary drainage system and predisposing factors for the occurrence of symptomatic urinary infection. (6 Patients, who are stabilised in a particular method of bladder drainage, and therefore, unlikely to make a permanent change in the method of bladder drainage (e.g. from penile sheath drainage to the use of long-term indwelling catheter during a foreseeable future. Methods The participants will be observed for a period of 36 months. A staff of the spinal injuries unit will contact the participants by telephone every two weeks on a mutually agreed day and time. The information obtained during this standardised

  11. Dipsacus asperoides (Xue Duan) inhibits spinal cord injury-induced ...

    African Journals Online (AJOL)

    Keywords: IKK/NF-kB pathway, MPO activity, Spinal cord injury, Inflammation, Xue Duan, Dipsacus asperoides. Tropical ..... transcription factor in chronic inflammatory diseases. N ... improved locomotor function recovery in rats after acute.

  12. Restoring voluntary control of locomotion after paralyzing spinal cord injury

    National Research Council Canada - National Science Library

    van den Brand, Rubia; Heutschi, Janine; Barraud, Quentin; DiGiovanna, Jack; Bartholdi, Kay; Huerlimann, Michèle; Friedli, Lucia; Vollenweider, Isabel; Moraud, Eduardo Martin; Duis, Simone; Dominici, Nadia; Micera, Silvestro; Musienko, Pavel; Courtine, Grégoire

    2012-01-01

    Half of human spinal cord injuries lead to chronic paralysis. Here, we introduce an electrochemical neuroprosthesis and a robotic postural interface designed to encourage supraspinally mediated movements in rats with paralyzing lesions...

  13. 脊髓损伤患者照顾者生命质量的研究进展%Research progress on the life quality of caregivers of patients with spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    李薇; 杜红娣; 刘晓萱

    2016-01-01

    本文综述了脊髓损伤患者照顾者生命质量的研究现状,分析了影响脊髓损伤患者照顾者生命质量的因素,指出了改善脊髓损伤患者照顾者生活质量的干预措施,为改善脊髓损伤主要照顾者的生命质量提供信息。%The current states of the life quality of caregivers of patients with spinal cord injury is reviewed and the influence factors are analyzed .The intervention measures have been put forward , so as to provide useful reference for improving the life quality of caregivers of patients with spinal cord injury .

  14. Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis

    Directory of Open Access Journals (Sweden)

    Miller LE

    2016-03-01

    Full Text Available Larry E Miller,1 Angela K Zimmermann,1 William G Herbert,1,2 1Miller Scientific Consulting, Inc., Asheville, NC, 2Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA Background: Powered exoskeletons are designed to safely facilitate ambulation in patients with spinal cord injury (SCI. We conducted the first meta-analysis of the available published research on the clinical effectiveness and safety of powered exoskeletons in SCI patients. Methods: MEDLINE and EMBASE databases were searched for studies of powered exoskeleton-assisted walking in patients with SCI. Main outcomes were analyzed using fixed and random effects meta-analysis models. Results: A total of 14 studies (eight ReWalk™, three Ekso™, two Indego®, and one unspecified exoskeleton representing 111 patients were included in the analysis. Training programs were typically conducted three times per week, 60–120 minutes per session, for 1–24 weeks. Ten studies utilized flat indoor surfaces for training and four studies incorporated complex training, including walking outdoors, navigating obstacles, climbing and descending stairs, and performing activities of daily living. Following the exoskeleton training program, 76% of patients were able to ambulate with no physical assistance. The weighted mean distance for the 6-minute walk test was 98 m. The physiologic demand of powered exoskeleton-assisted walking was 3.3 metabolic equivalents and rating of perceived exertion was 10 on the Borg 6–20 scale, comparable to self-reported exertion of an able-bodied person walking at 3 miles per hour. Improvements in spasticity and bowel movement regularity were reported in 38% and 61% of patients, respectively. No serious adverse events occurred. The incidence of fall at any time during training was 4.4%, all occurring while tethered using a first-generation exoskeleton and none resulting in injury. The incidence of bone fracture during training was 3

  15. MR-pathologic comparisons of wallerian degeneration in spinal cord injury.

    Science.gov (United States)

    Becerra, J L; Puckett, W R; Hiester, E D; Quencer, R M; Marcillo, A E; Post, M J; Bunge, R P

    1995-01-01

    To describe the MR manifestations and temporal course of wallerian degeneration that occurs above and below a spinal cord injury, and to compare the MR findings with postmortem histopathology. Twenty-four postmortem spinal cords from patients with cervical (n = 14), thoracic (n = 6), and lumbar (n = 4) cord injuries were studied with axial T1- and T2-weighted spin-echo MR imaging. Injury-to-death intervals varied from 8 days to 23 years. The images were examined for alteration of signal above and below the injury site. Histologic studies of these cords with axon, myelin, and connective tissue stains were performed at levels equivalent to the MR sections. Immunohistochemical analysis using antibodies to glial fibrillary acetic protein was also performed on 19 cords. Pathologic-imaging comparisons were made. MR images showed increased signal intensity in the dorsal columns above the injury level and in the lateral corticospinal tracts below the injury level in all cases in which cord injury had occurred 7 or more weeks before death. In early postinjury survival times (8 days and 12 days) MR findings were normal; histologically there was early wallerian degeneration in only the dorsal columns at 8 days and in both the lateral and dorsal columns at 12 days. MR showed wallerian degeneration in all cases examined at 7 weeks after injury and thereafter. Wallerian degeneration was demonstrated by histology and MR in all specimens in which the injury-to-death interval was greater than 7 weeks. Recognition of wallerian degeneration on MR allows complete analysis of the injury, explains abnormal MR signals at sites remote from the epicenter of the injury, and may be useful in the future in the timing and planning of therapeutic interventions.

  16. International spinal cord injury pulmonary function basic data set

    DEFF Research Database (Denmark)

    Biering-Sørensen, Fin; Krassioukov, A; Alexander, M S

    2012-01-01

    To develop the International Spinal Cord Injury (SCI) Pulmonary Function Basic Data Set within the framework of the International SCI Data Sets in order to facilitate consistent collection and reporting of basic bronchopulmonary findings in the SCI population.......To develop the International Spinal Cord Injury (SCI) Pulmonary Function Basic Data Set within the framework of the International SCI Data Sets in order to facilitate consistent collection and reporting of basic bronchopulmonary findings in the SCI population....

  17. International spinal cord injury musculoskeletal basic data set

    DEFF Research Database (Denmark)

    Biering-Sørensen, Fin; Burns, A S; Curt, A

    2012-01-01

    To develop an International Spinal Cord Injury (SCI) Musculoskeletal Basic Data Set as part of the International SCI Data Sets to facilitate consistent collection and reporting of basic musculoskeletal findings in the SCI population.Setting:International.......To develop an International Spinal Cord Injury (SCI) Musculoskeletal Basic Data Set as part of the International SCI Data Sets to facilitate consistent collection and reporting of basic musculoskeletal findings in the SCI population.Setting:International....

  18. International Spinal Cord Injury Urinary Tract Infection Basic Data Set

    DEFF Research Database (Denmark)

    Goetz, L L; Cardenas, D D; Kennelly, M

    2013-01-01

    To develop an International Spinal Cord Injury (SCI) Urinary Tract Infection (UTI) Basic Data Set presenting a standardized format for the collection and reporting of a minimal amount of information on UTIs in daily practice or research.......To develop an International Spinal Cord Injury (SCI) Urinary Tract Infection (UTI) Basic Data Set presenting a standardized format for the collection and reporting of a minimal amount of information on UTIs in daily practice or research....

  19. Study of position control to cervical spinal cord injury of hemiplegic patients during functional activities%颈髓挫伤致偏瘫患者功能锻炼中抗肌痉挛体位的研究

    Institute of Scientific and Technical Information of China (English)

    何瑞琼

    2009-01-01

    目的 抗痉挛体位对颈髓挫伤致瘫痪患者功能锻炼中降低肌痉挛的效果.方法 观察82例颈髓挫伤致偏瘫患者功能锻炼时肌痉挛情况及抗痉挛降低肌痉挛的情况.结果 颈髓挫伤致瘫痪患者,体位转换、移动活动、平衡活动及一些力量性训练过程中发生患侧上肢屈肌痉挛(不自主屈肘或握拳)和下肢伸肌痉挛(不自主膝过伸或踝趾屈)的阳性率,以及采取对抗痉挛体位1个月后,患者肌痉挛被抑制.结论 颈髓挫伤致瘫痪患者早期一些功能活动可以诱发肌肉痉挛产生,抗痉挛抑制体位对此有控制效果.%Objective To study position control to cervical spinal cord injury of hemiplegic patients during functional activities. Methods 82 cases of cervical spinal cord injury of hemiplegic patients functional activities and position control was observated. Results The cervical spinal cord injury of hemiplegic patients while body transfer, balance and strengthening, functional activities easily induced muscles spasticity, against muscles spasticity can in-crease the muscles spasticity. Conclusion The inhibition of muscles spasticity can increased the muscles spasticity the patients of cervical spinal cord injury of hemiplegic.

  20. Directing Spinal Cord Plasticity: The Impact of Stretch Therapy on Functional Recovery after Spinal Cord Injury

    Science.gov (United States)

    2014-10-01

    atrophy. Interestingly, there is a clinical phenomenon that stretching can lead to muscle fiber hypertrophy , but that doesn’t appear to be...specific muscle groups) on functional recovery after spinal cord injury in a rat model. We have undertaken these studies because of an observation we...spinal cord injury, locomotor recovery, physical therapy, muscle stretch, joint range- of-motion, rat. Overall Project Summary: In this, the

  1. Directing Spinal Cord Plasticity: The Impact of Stretch Therapy on Functional Recovery after Spinal Cord Injury

    Science.gov (United States)

    2015-10-01

    2. Shown are stereotypic patterns of clonus (1) and spasms (2) recorded from muscles in the limb contralateral to the one being stretched. The clonus...therapy maneuvers involving force or torque applied to specific muscle groups) on functional recovery after spinal cord injury in a rat model. We have...situation. Key Words: spinal cord injury, locomotor recovery, physical therapy, muscle stretch, joint range- of-motion, rat. Overall Project Summary

  2. A Surgery Protocol for Adult Zebrafish Spinal Cord Injury

    Institute of Scientific and Technical Information of China (English)

    Ping Fang; Jin-Fei Lin; Hong-Chao Pan; Yan-Qin Shen; Melitta Schachner

    2012-01-01

    Adult zebrafish has a remarkable capability to recover from spinal cord injury,providing an excellent model for studying neuroregeneration.Here we list equipment and reagents,and give a detailed protocol for complete transection of the adult zebrafish spinal cord.In this protocol,potential problems and their solutions are described so that the zebrafish spinal cord injury model can be more easily and reproducibly performed.In addition,two assessments are introduced to monitor the success of the surgery and functional recovery:one test to assess free swimming capability and the other test to assess extent of neuroregeneration by in vivo anterograde axonal tracing.In the swimming behavior test,successful complete spinal cord transection is monitored by the inability of zebrafish to swim freely for 1 week after spinal cord injury,followed by the gradual reacquisition of full locomotor ability within 6 weeks after injury.As a morphometric correlate,anterograde axonal tracing allows the investigator to monitor the ability of regenerated axons to cross the lesion site and increasingly extend into the gray and white matter with time after injury,confirming functional recovery.This zebrafish model provides a paradigm for recovery from spinal cord injury,enabling the identification of pathways and components of neuroregeneration.

  3. Physical and rehabilitation medicine (PRM) care pathways: "spinal cord injury".

    Science.gov (United States)

    Albert, T; Beuret Blanquart, F; Le Chapelain, L; Fattal, C; Goossens, D; Rome, J; Yelnik, A P; Perrouin Verbe, B

    2012-09-01

    This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. The patients after spinal cord injury are divided into five categories according to the severity of the impairments, each one being treated according to the same six parameters according to the International Classification of Functioning, Disability and Health (WHO), while taking into account personal and environmental factors that could influence the needs of these patients.

  4. Research status on anxiety and depression of patients with spinal cord injury at home and abroad%国内外脊髓损伤患者焦虑抑郁情绪研究现状

    Institute of Scientific and Technical Information of China (English)

    梁丽梅; 李慧芬; 姜连英; 周文华

    2015-01-01

    Anxiety and depression were common psychological problems of patients with spinal cord injury.To understand the status of anxiety and depression of patients with spinal cord injury at home and abroad,enhance the recognization of anxiety and depression,and provide reference for nurses in research psychological care,the degree of anxiety and depression,related factors and psychological care for the patients with spinal cord injury at home and in abroad were reviewed.%焦虑抑郁是脊髓损伤患者常见的心理问题,通过对国内外脊髓损伤患者焦虑抑郁程度、相关因素及心理护理进行综述,以了解国内外脊髓损伤患者焦虑抑郁情绪研究现状,加强护理人员对脊髓损伤患者焦虑抑郁的认识,为护理人员进行心理护理提供参考.

  5. Relationship Between Bone Mineral Density and Functional Parameters of Paraplegic Patients in Short-Term After Spinal Cord Injury-Original Investigation

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    Duygu Geler Külcü

    2008-12-01

    Full Text Available Aim: To determine the relationship between bone mineralization and functional activity level of paraplegic patients in short-term after spinal cord injury (SCI. Material and Methods: Thirty paraplegic patients and twentynine healthy controls were admitted to this study. Bone mineral density (BMD and Z-scores, together with serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone and 25-hydroxyvitamin-D levels, urinary calcium and deoxypyridinoline excretion were measured. All patients underwent a rehabilitation program including range of motion and progressive resistance exercises, upper body ergometry exercises, standing training with long leg orthosis, wheelchair ambulation or walking either by orthosis or walking aids five times/week during hospitalization. Results: There was no difference between the groups regarding BMD values and Z-scores. Mean serum calcium and parathyroid hormone levels were lower (p=0.016 and p<0.001, respectively, serum phosphorus and alkaline phosphatase levels were higher (p<0.001 and p=0.049, respectively in the paraplegics as compared to the controls. Positive correlations were found between the radius BMD values and total duration of upper body ergometry exercise (r=0.550, p=0.027 and wheelchair use (r=0.622, p=0.010 and also between the femur BMD values and total duration of therapeutic standing (r=0.351, p=0.039. There was an inverse relationship between the femur BMD values and total duration of immobilization (r= -0.404, p= 0.033. Conclusion: Early rehabilitation interventions may prevent bone demineralization. Paraplegic patients should be followed and evaluated also in long term for the increased risk of osteoporosis. (From the World of Osteoporosis 2008;14: 57-61

  6. Neuromodulation by surface electrical stimulation of peripheral nerves for reduction of detrusor overactivity in patients with spinal cord injury: A pilot study.

    Science.gov (United States)

    Ojha, Rajdeep; George, Jacob; Chandy, Bobeena R; Tharion, George; Devasahayam, Suresh R

    2015-03-01

    To demonstrate reduction in detrusor overactivity using surface electrical stimulation of posterior tibial nerve (PTN) or dorsal penile nerve (DPN) in patients with spinal cord injury (SCI). Patients with SCI with symptoms of urinary urgency/leaks, with cystometrogram (CMG) proven detrusor overactivity were recruited in this study. Ten persons with observable F-wave from tibial nerve were included in the PTN group. Five persons who had F-wave absent but preserved bulbocavernosus reflex were included in the DPN group. Stimulation was given at 20 Hz, 10-40 mA for 20 minutes/session/day for 14 consecutive days. Detrusor overactivity was recorded using CMG on days 1 and 15. Rehabilitation Institute, Department of Physical Medicine and Rehabilitation, Christian Medical College and Hospital, Vellore, TN, India. Patients with SCI. Surface stimulation of peripheral nerves for reduction of detrusor overactivity. Qualitative analysis using voiding diary data and quantitative analysis using CMG data comparing pre- and post-intervention. P value obtained from voiding chart was 0.021 for PTN and 0.062 for DPN. P value obtained from CMG data was not significant in both groups. In one subject, treatment was extended to 4 weeks and further improvement in voiding diary was seen. In this pilot study of 15 patients, voiding chart data showed statistically significant improvement following PTN stimulation and trend of improvement following DPN stimulation. However, the CMG data were not statistically significant in this sample population. Further studies with larger, appropriately powered sample size would be helpful to demonstrate the associations of symptoms with CMG data. Trial registration CTRI no.; CTRI/2012/12/003234; CMCH Approval no.: CMC/IRB/6735/2008/12/18.

  7. The effects of anodal transcranial direct current stimulation and patterned electrical stimulation on spinal inhibitory interneurons and motor function in patients with spinal cord injury.

    Science.gov (United States)

    Yamaguchi, Tomofumi; Fujiwara, Toshiyuki; Tsai, Yun-An; Tang, Shuen-Chang; Kawakami, Michiyuki; Mizuno, Katsuhiro; Kodama, Mitsuhiko; Masakado, Yoshihisa; Liu, Meigen

    2016-06-01

    Supraspinal excitability and sensory input may play an important role for the modulation of spinal inhibitory interneurons and functional recovery among patients with incomplete spinal cord injury (SCI). Here, we investigated the effects of anodal transcranial direct current stimulation (tDCS) combined with patterned electrical stimulation (PES) on spinal inhibitory interneurons in patients with chronic incomplete SCI and in healthy individuals. Eleven patients with incomplete SCI and ten healthy adults participated in a single-masked, sham-controlled crossover study. PES involved stimulating the common peroneal nerve with a train of ten 100 Hz pulses every 2 s for 20 min. Anodal tDCS (1 mA) was simultaneously applied to the primary motor cortex that controls the tibialis anterior muscle. We measured reciprocal inhibition and presynaptic inhibition of a soleus H-reflex by stimulating the common peroneal nerve prior to tibial nerve stimulation, which elicits the H-reflex. The inhibition was assessed before, immediately after, 10 min after and 20 min after the stimulation. Compared with baseline, simultaneous application of anodal tDCS with PES significantly increased changes in disynaptic reciprocal inhibition and long-latency presynaptic inhibition in both healthy and SCI groups for at least 20 min after the stimulation (all, p stimulation (p = 0.004). In conclusion, anodal tDCS combined with PES could induce spinal plasticity and improve ankle movement in patients with incomplete SCI.

  8. Spinal cord injury after blunt cervical spine trauma: correlation of soft-tissue damage and extension of lesion.

    Science.gov (United States)

    Martínez-Pérez, R; Paredes, I; Cepeda, S; Ramos, A; Castaño-León, A M; García-Fuentes, C; Lobato, R D; Gómez, P A; Lagares, A

    2014-05-01

    In patients with spinal cord injury after blunt trauma, several studies have observed a correlation between neurologic impairment and radiologic findings. Few studies have been performed to correlate spinal cord injury with ligamentous injury. The purpose of this study was to retrospectively evaluate whether ligamentous injury or disk disruption after spinal cord injury correlates with lesion length. We retrospectively reviewed 108 patients diagnosed with traumatic spinal cord injury after cervical trauma between 1990-2011. Plain films, CT, and MR imaging were performed on patients and then reviewed for this study. MR imaging was performed within 96 hours after cervical trauma for all patients. Data regarding ligamentous injury, disk injury, and the extent of the spinal cord injury were collected from an adequate number of MR images. We evaluated anterior longitudinal ligaments, posterior longitudinal ligaments, and the ligamentum flavum. Length of lesion, disk disruption, and ligamentous injury association, as well as the extent of the spinal cord injury were statistically assessed by means of univariate analysis, with the use of nonparametric tests and multivariate analysis along with linear regression. There were significant differences in lesion length on T2-weighted images for anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum in the univariate analysis; however, when this was adjusted by age, level of injury, sex, and disruption of the soft tissue evaluated (disk, anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum) in a multivariable analysis, only ligamentum flavum showed a statistically significant association with lesion length. Furthermore, the number of ligaments affected had a positive correlation with the extension of the lesion. In cervical spine trauma, a specific pattern of ligamentous injury correlates with the length of the spinal cord lesion in MR imaging studies

  9. A cost-utility analysis of sacral anterior root stimulation (SARS) compared with medical treatment in patients with complete spinal cord injury with a neurogenic bladder.

    Science.gov (United States)

    Morlière, Camille; Verpillot, Elise; Donon, Laurence; Salmi, Louis-Rachid; Joseph, Pierre-Alain; Vignes, Jean-Rodolphe; Bénard, Antoine

    2015-12-01

    Sacral anterior root stimulation (SARS) and posterior sacral rhizotomy restores the ability to urinate on demand with low residual volumes, which is a key for preventing urinary complications that account for 10% of the causes of death in patients with spinal cord injury with a neurogenic bladder. Nevertheless, comparative cost-effectiveness results on a long time horizon are lacking to adequately inform decisions of reimbursement. This study aimed to estimate the long-term cost-utility of SARS using the Finetech-Brindley device compared with medical treatment (anticholinergics+catheterization). The following study design is used for the paper: Markov model elaborated with a 10-year time horizon; with four irreversible states: (1) initial treatment, (2) year 1 of surgery for urinary complication, (3) year >1 of surgery for urinary complication, and (4) death; and reversible states: urinary calculi; Finetech-Brindley device failures. The sample consisted of theoretical cohorts of patients with a complete spinal cord lesion since ≥1 year, and a neurogenic bladder. Effectiveness was expressed as quality adjusted life years (QALYs). Costs were valued in EUR 2013 in the perspective of the French health system. A systematic review and meta-analyses were performed to estimate transition probabilities and QALYs. Costs were estimated from the literature, and through simulations using the 2013 French prospective payment system classification. Probabilistic analyses were conducted to handle parameter uncertainty. In the base case analysis (2.5% discount rate), the cost-utility ratio was 12,710 EUR per QALY gained. At a threshold of 30,000 EUR per QALY the probability of SARS being cost-effective compared with medical treatment was 60%. If the French Healthcare System reimbursed SARS for 80 patients per year during 10 years (anticipated target population), the expected incremental net health benefit would be 174 QALYs, and the expected value of perfect information (EVPI

  10. Investigation of the protective effect of erythropoietin on spinal cord injury in rats.

    Science.gov (United States)

    Hong, Zhenghua; Hong, Huaxing; Chen, Haixiao; Wang, Zhangfu; Hong, Dun

    2011-09-01

    Erythropoietin (EPO) is a promising therapeutic agent used in a variety of spinal cord injuries. Therefore, identifying the specific molecular pathway mediating the neuronal protective effect of EPO after spinal cord injury (SCI) is of great value to the patients concerned. Platelet-derived growth factor (PDGF)-B is an important factor in the recovery of neurological function. We explored changes in the expression of PDGF-B in spinal cord injury rats after receiving EPO treatment. We used a weight-drop contusion SCI model, and EPO treatment group rats received single doses of EPO (1,000 U/kg i.p.) immediately after the operation. Seven days after the operation, the results revealed a more rapid recovery as noted by the higher BBB scores, less disruption and more neuronal regeneration of the spinal cord in the EPO treatment group than that in the SCI group. PDGF-B expression also increased in the EPO treatment group compared to that in the SCI group (PEPO on spinal cord injury in rats, which may help to explain the quick recovery after EPO treatment of spinal cord injury.

  11. Optical measurement of blood flow changes in spinal cord injury

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    Phillips, J P; Kyriacou, P A [Biomedical Engineering Research Group, City University London, Northampton Square, London (United Kingdom); George, K J [Neuroscience Centre, Queen Mary, University of London, Mile End, London (United Kingdom); Langford, R M, E-mail: justin.phillips.1@city.ac.u [Pain and Anaesthesia Research Centre, St Bartholomew' s Hospital, West Smithfield, London (United Kingdom)

    2010-07-01

    Little is known about cell death in spinal cord tissue following compression injury, despite compression being a key component of spinal injuries. Currently models are used to mimic compression injury in animals and the effects of the compression evaluated by observing the extent and duration of recovery of normal motor function in the days and weeks following the injury. A fibreoptic photoplethysmography system was used to investigate whether pulsation of the small arteries in the spinal cord occurred before, during and after compressive loads were applied to the tissue. It was found that the signal amplitudes were reduced and this reduction persisted for at least five minutes after the compression ceased. It is hoped that results from this preliminary study may improve knowledge of the mechanism of spinal cord injury.

  12. in athletes with spinal cord injuries

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    RC Pritchett

    2015-09-01

    Full Text Available Sweat production is crucial for thermoregulation. However, sweating can be problematic for individuals with spinal cord injuries (SCI, as they display a blunting of sudomotor and vasomotor responses below the level of the injury. Sweat gland density and eccrine gland metabolism in SCI are not well understood. Consequently, this study examined sweat lactate (S-LA (reflective of sweat gland metabolism, active sweat gland density (SGD, and sweat output per gland (S/G in 7 SCI athletes and 8 able-bodied (AB controls matched for arm ergometry VO2peak. A sweat collection device was positioned on the upper scapular and medial calf of each subject just prior to the beginning of the trial, with iodine sweat gland density patches positioned on the upper scapular and medial calf. Participants were tested on a ramp protocol (7 min per stage, 20 W increase per stage in a common exercise environment (21±1°C, 45-65% relative humidity. An independent t-test revealed lower (p<0.05 SGD (upper scapular for SCI (22.3 ±14.8 glands · cm-2 vs. AB. (41.0 ± 8.1 glands · cm-2. However, there was no significant difference for S/G between groups. S-LA was significantly greater (p<0.05 during the second exercise stage for SCI (11.5±10.9 mmol · l-1 vs. AB (26.8±11.07 mmol · l-1. These findings suggest that SCI athletes had less active sweat glands compared to the AB group, but the sweat response was similar (SLA, S/G between AB and SCI athletes. The results suggest similar interglandular metabolic activity irrespective of overall sweat rate.

  13. Physical therapy treatment time during inpatient spinal cord injury rehabilitation

    Science.gov (United States)

    Taylor-Schroeder, Sally; LaBarbera, Jacqueline; McDowell, Shari; Zanca, Jeanne M.; Natale, Audrey; Mumma, Sherry; Gassaway, Julie; Backus, Deborah

    2011-01-01

    Background/objective To describe the nature and distribution of activities during physical therapy (PT) delivered in inpatient spinal cord injury (SCI) rehabilitation and discuss predictors (patient and injury characteristics) of the amount of time spent in PT for specific treatment activities. Methods Six hundred patients from six inpatient SCI centers were enrolled in the SCIRehab study. Physical therapists documented details, including time spent, of treatment provided during 37 306 PT sessions that occurred during inpatient SCI rehabilitation. Ordinary least squares regression models associated patient and injury characteristics with time spent in specific PT activities. Results SCIRehab patients received a mean total of 55.3 hours of PT over the course of their rehabilitation stay. Significant differences among four neurologic groups were seen in the amount of time spent on most activities, including the most common PT activities of strengthening exercises, stretching, transfer training, wheelchair mobility training, and gait training. Most PT work (77%) was provided in individual therapy sessions; the remaining 23% was done in group settings. Patient and injury characteristics explained only some of the variations seen in time spent on wheelchair mobility, transfer and bed mobility training, and range of motion/stretching. Conclusion Analysis yielded both expected and unexpected trends in SCI rehabilitation. Significant variation was seen in time spent on PT activities within and among injury groups. Providing therapeutic strengthening treatments consumed the greatest proportion of PT time. About one-quarter of all PT services were provided in group settings. Details about services provided, including time spent, will serve as a starting point in detailing the optimal treatment delivery for maximal outcomes. PMID:21675354

  14. An update on spinal cord injury research

    Institute of Scientific and Technical Information of China (English)

    He-Qi Cao; Er-Dan Dong

    2013-01-01

    Spinal cord injury (SCI) can have a range of debilitating effects and permanently alter the capabilities and quality of life of survivors.The first specialized centers of care for SCI were established in 1944 and since then an increasing amount of research has been carried out in this area.Despite this,the present treatment and care levels for SCI are not comparable to those in other areas of medicine.In the clinic,the aim of SCI treatment is primarily to limit secondary damage by reducing compression in trauma spots and stabilizing the spinal column.Currently,no effective strategy for functional recovery is offered.In this review,we focus on research progress on the molecular mechanisms underlying SCI,and assess the treatment outcomes of SCI in animal models,i.e.,neurotrophins and stem cells are discussed as pre-clinical therapies in animal models.We also assess the resources available and national research projects carried out on SCI in China in recent years,as well as making recommendations for the future allocation of funds in this area.

  15. 脊柱损伤合并多发伤患者急诊预见性护理效果观察%Effect of emergency foresight nursing on patients with spinal cord injury accompanied by multiple injuries

    Institute of Scientific and Technical Information of China (English)

    盛海峰; 石玉岚; 杨海涛

    2015-01-01

    Objective To study the effect of emergency foresight nursing care and reasonable nursing measures on patients with spinal cord injury combined with multiple injuries .Methods Eighty-six patients with spinal cord injury and multiple trauma were enrolled in emergency department of this hospital from October 2010 to October 2013.According to the toss of a coin they were random-ly divided into the observation group ( n=44 ) and the control group ( n=42 ) .The observation group received foreseeable nursing whereas the control group shared routine nursing care .The ambulance arrival time ( the time from onset of disease to the ambulance ar-rival), the effective rescue time (the time from the ambulance rrival to patients ’ hospitalization), the successful rate of first aid (as a criterion, after the rescue , the vital signs of the patients were relieved and transfer to hospitalization or surgical treatment ) , and inci-dence and patients’ negative emotions (fear, anxiety, irritability) were recorded, and the results were statistically analyzed. Results There was no significant difference in ambulance arrival time .In observation group , the average effective rescue time was (27.7 ±4.4) min, the success rate of first aid was 95.5%, incidence of negative emotions was 13.6%.In the control group, the av-erage effective rescue time was (34.6 ±4.1) min, the success rate of first aid was 80.9%, and negative emotions incidence was 28.6%.The difference was significant ( P<0.05) between the two groups .Conclusions For multiple injuries with spinal cord inju-ry, the basic principle is to save the lives of patients .Owing to difficulties in early diagnosis and easily missed diagnosis of spinal cord injury in multiple trauma patients with spinal cord injury , neck mobility should be strictly limited and further spinal damage should be prevented, which is particularly important to the treatment .%目的:观察脊柱损伤合并多发伤患者的急诊预见性护理的效果

  16. DIFFERENT TYPES OF INSPIRATORY MUSCLE TRAINING PROVIDES BETTERMENT IN ALTERED PULMONARY FUNCTIONS IN UPPER THORACIC SPINAL CORD INJURIES

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    Muruganandam Periyasamy

    2016-08-01

    Full Text Available Background: Respiratory problems are usual in upper thoracic spinal cord injuries when compared to Lower thoracic spinal cord injuries. Generally there are frequent respiratory complications in the individuals with spinal cord injuries. The complications of the respiratory system are severe and more prevalent source of morbidity and mortality after the spinal cord injury due to the inefficient breathing capacity including inspiratory and expiratory abilities. The present study represents the inspiratory muscle training especially in upper thoracic spinal cord injury patients to assess the improvement in the pulmonary functions. Methods: Twenty five patients with the age between 25 -40 years with the upper spinal cord injuries were selected in the present study in order to assess the efficacy of the training. Several types of exercises were practiced including diaphragmatic breathing exercises, incentive spirometry, active cycle of breathing technique and weight training. COPD Conditions, Chest wall deformities, Hypertensive patients, Cardio vascular problems were excluded in the study. Results: The results from the study showed that significant changes were found in the patients treated with all the above mentioned techniques. Axillary level, nipple level, Xiphisternum levels were analysed and the results found to be significant after the treatment. Incentive spirometry and peak flow meter observations were also found to be significant when compare to the pretreatment. Conclusion: The present study conclude that the combined effect of incentive spriometry, diaphragmatic breathing exercises, and active cycle of breathing technique is more effective in improving the pulmonary functions in upper thoracic spinal cord injuries than single method efficiency.

  17. Occupational therapy treatment time during inpatient spinal cord injury rehabilitation

    Science.gov (United States)

    Foy, Teresa; Perritt, Ginger; Thimmaiah, Deepa; Heisler, Lauren; Offutt, Jennifer Lookingbill; Cantoni, Kara; Hseih, Ching-Hui; Gassaway, Julie; Ozelie, Rebecca; Backus, Deborah

    2011-01-01

    Background Occupational therapy (OT) is a critical component of the rehabilitation process after spinal cord injury (SCI), the constitution of which has not been studied or documented in full detail previously. Objective To describe the type and distribution of SCI rehabilitation OT activities, including the amount of time spent on evaluation and treatment, and to discuss predictors (patient and injury characteristics) of the amount of time dedicated to OT treatment activities. Methods Six inpatient rehabilitation centers enrolled 600 patients with traumatic SCI in the first year of the SCIRehab. Occupational therapists documented 32 512 therapy sessions including time spent and specifics of each therapeutic activity. Analysis of variance and contingency tables/chi-square tests were used to test differences across neurologic injury groups for continuous and categorical variables. Results SCIRehab patients received a mean total of 52 hours of OT over the course of their rehabilitation stay. Statistically significant differences among four neurologic injury groups were seen in time spent on each OT activity. The activities that consumed the most OT time (individual and group sessions combined) were strengthening/endurance exercises, activities of daily living (ADLs), range of motion (ROM)/stretching, education, and a grouping of ‘therapeutic activities’ that included tenodesis training, fine motor activities, manual therapy, vestibular training, edema management, breathing exercise, cognitive retraining, visual/perceptual training desensitization, and don/doff adaptive equipment. Seventy-seven percent of OT work occurred in individual treatment sessions, with the most frequent OT activity involving ADLs. The variation in time (mean minutes per week) spent on OT ROM/stretching, ADLs, transfer training, assessment, and therapeutic activities can be explained in part by patient and injury characteristics, such as admission Functional Independence Measure (FIM

  18. Spinal cord injury in Parkour sport (free running: a rare case report

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    Derakhshan Nima

    2014-06-01

    Full Text Available A 24-year-old male was transferred to the emergency department while being in the state of quadriplegia with a history of performing Parkour sport, which is also called double front flip. Neurological examination revealed that the patient’s muscle power was 0/5 at all extremities. The patient did not show any sense of light touch or pain in his extremities. In radiological studies, cervical spine X-ray and CT scan images showed C4-C5 subluxation with bilateral locked facets and spinal cord injury. The results of this very rare case study revealed that exercising Parkour sport without taking into account safety standards could result in irreversible injuries to the cervical spinal cord with fatal outcome. Key words: Spinal cord injuries; Cervical vertebrae; Athletic injuries

  19. Matrix metalloproteinases limit functional recovery after spinal cord injury by modulation of early vascular events.

    Science.gov (United States)

    Noble, Linda J; Donovan, Frances; Igarashi, Takuji; Goussev, Staci; Werb, Zena

    2002-09-01

    Inflammation in general and proteinases generated as a result are likely mediators of early secondary pathogenesis after spinal cord injury. We report that matrix metalloproteinase-9 (MMP-9) plays an important role in blood-spinal cord barrier dysfunction, inflammation, and locomotor recovery. MMP-9 was present in the meninges and neurons of the uninjured cord. MMP-9 increased rapidly after a moderate contusion spinal cord injury, reaching a maximum at 24 hr, becoming markedly reduced by 72 hr, and not detectable at 7 d after injury. It was seen in glia, macrophages, neutrophils, and vascular elements in the injured spinal cord at 24 hr after injury. The natural tissue inhibitors of MMPs were unchanged over this time course. MMP-9-null mice exhibited significantly less disruption of the blood-spinal cord barrier, attenuation of neutrophil infiltration, and significant locomotor recovery compared with wild-type mice. Similar findings were observed in mice treated with a hydroxamic acid MMP inhibitor from 3 hr to 3 d after injury, compared with the vehicle controls. Moreover, the area of residual white matter at the lesion epicenter was significantly greater in the inhibitor-treated group. This study provides evidence that MMP-9 plays a key role in abnormal vascular permeability and inflammation within the first 3 d after spinal cord injury, and that blockade of MMPs during this critical period attenuates these vascular events and leads to improved locomotor recovery. Our findings suggest that early inhibition of MMPs may be an efficacious strategy for the spinal cord-injured patient.

  20. Wheelchair cushions for persons with spinal cord injury: an update.

    Science.gov (United States)

    Garber, S L; Dyerly, L R

    1991-06-01

    Occupational therapists frequently prescribe wheelchair cushions to reduce the risk of pressure sores in patients with spinal cord injury. In an earlier study (Garber, 1985b), Roho cushions were prescribed for the greatest number of subjects studied. The present study of 197 subjects updates these data and describes current prescription patterns, the use of cushions over time, satisfaction with prescribed cushions, and the occurrence of pressure sores with prescribed cushions. The study shows that the Jay cushion was prescribed most frequently for the current subjects, although it was not recommended for all persons with spinal cord injury. In the second phase of the present study, involving 30 subjects, 30% of the subjects discontinued use of the prescribed cushion. Skin breakdown and the discovery of alternative solutions were given as primary reasons. There was no significant difference in the incidence of pressure sores between subjects who continued to use their prescribed cushions and those who did not. This research supports the conclusion of earlier studies that no one wheelchair cushion is universally effective for all persons and that individual evaluation and routine reassessment are essential in reducing the occurrence of pressure sores.

  1. Training a Spinal Cord Injury Rehabilitation Team in Motivational Interviewing

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    Pilar Lusilla-Palacios

    2015-01-01

    Full Text Available Background. An acute spinal cord injury (ASCI is a severe condition that requires extensive and very specialized management of both physical and psychological dimensions of injured patients. Objective. The aim of the part of the study reported here was twofold: (1 to describe burnout, empathy, and satisfaction at work of these professionals and (2 to explore whether a tailored program based on motivational interviewing (MI techniques modifies and improves such features. Methods. This paper presents findings from an intervention study into a tailored training for professionals (N=45 working in a spinal cord injury (SCI unit from a general hospital. Rehabilitation professionals’ empathy skills were measured with the Jefferson Scale of Physician Empathy (JSPE, burnout was measured with the Maslach Burnout Inventory (MBI, and additional numeric scales were used to assess the perceived job-related stress and perceived satisfaction with job. Results. Findings suggest that professionals are performing quite well and they refer to satisfactory empathy, satisfaction at work, and no signs of burnout or significant stress both before and after the training. Conclusions. No training effect was observed in the variables considered in the study. Some possible explanations for these results and future research directions are discussed in depth in this paper. The full protocol of this study is registered in ClinicalTrials.gov (identifier: NCT01889940.

  2. Methylprednisolone for acute spinal cord injury: an increasingly philosophical debate

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    Christian A Bowers

    2016-01-01

    Full Text Available Following publication of NASCIS II, methylprednisolone sodium succinate (MPSS was hailed as a breakthrough for patients with acute spinal cord injury (SCI. MPSS use for SCI has since become very controversial and it is our opinion that additional evidence is unlikely to break the stalemate amongst clinicians. Patient opinion has the potential to break this stalemate and we review our recent findings which reported that spinal cord injured patients informed of the risks and benefits of MPSS reported a preference for MPSS administration. We discuss the implications of the current MPSS debate on translational research and seek to address some misconceptions which have evolved. As science has failed to resolve the MPSS debate we argue that the debate is an increasingly philosophical one. We question whether SCI might be viewed as a serious condition like cancer where serious side effects of therapeutics are tolerated even when benefits may be small. We also draw attention to the similarity between the side effects of MPSS and isotretinoin which is prescribed for the cosmetic disorder acne vulgaris. Ultimately we question how patient autonomy should be weighed in the context of current SCI guidelines and MPSS′s status as a historical standard of care.

  3. Methylprednisolone for acute spinal cord injury: an increasingly philosophical debate.

    Science.gov (United States)

    Bowers, Christian A; Kundu, Bornali; Hawryluk, Gregory W J

    2016-06-01

    Following publication of NASCIS II, methylprednisolone sodium succinate (MPSS) was hailed as a breakthrough for patients with acute spinal cord injury (SCI). MPSS use for SCI has since become very controversial and it is our opinion that additional evidence is unlikely to break the stalemate amongst clinicians. Patient opinion has the potential to break this stalemate and we review our recent findings which reported that spinal cord injured patients informed of the risks and benefits of MPSS reported a preference for MPSS administration. We discuss the implications of the current MPSS debate on translational research and seek to address some misconceptions which have evolved. As science has failed to resolve the MPSS debate we argue that the debate is an increasingly philosophical one. We question whether SCI might be viewed as a serious condition like cancer where serious side effects of therapeutics are tolerated even when benefits may be small. We also draw attention to the similarity between the side effects of MPSS and isotretinoin which is prescribed for the cosmetic disorder acne vulgaris. Ultimately we question how patient autonomy should be weighed in the context of current SCI guidelines and MPSS's status as a historical standard of care.

  4. Adult spinal cord ependymal layer: A promising pool of quiescent stem cells to treat spinal cord injury

    OpenAIRE

    Stavros eMalas; Elena ePanayiotou

    2013-01-01

    Spinal cord injury is a major health burden and currently there is no effective medical intervention. Research performed over the last decade revealed that cells surrounding the central canal of the adult spinal cord and forming the ependymal layer acquire stem cell properties either in vitro or in response to injury. Following spinal cord injury activated ependymal cells generate progeny cells which migrate to the injury site but fail to produce the appropriate type of cells in sufficient nu...

  5. Validation of the ICF Core Set for Vocational Rehabilitation from the perspective of patients with spinal cord injury using focus groups.

    Science.gov (United States)

    Aiachini, Beatrice; Cremascoli, Sonia; Escorpizo, Reuben; Pistarini, Caterina

    2016-01-01

    The International Classification of Functioning, Disability and Health (ICF) Core Set for Vocational Rehabilitation is an application of the ICF of the World Health Organization with the purpose of identifying problems and resources relevant for people in a vocational rehabilitation given a health condition. The objective of the study was to validate the Comprehensive ICF Core Set for Vocational Rehabilitation from the perspective of patients with spinal cord injury (SCI). The specific aims were to explore the aspects of functioning and health important to patients with SCI regarding return to work and to examine to what extent these aspects are represented by the current version of the Comprehensive ICF Core Set for Vocational Rehabilitation. Focus group interviews were conducted. The sampling of patients followed the maximum variation strategy. Sample size satisfied saturation criterion. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for the data analysis. After qualitative data analysis, the resulting concepts were linked to ICF categories according to established linking rules. Twenty-four SCI patients participated in seven focus groups. Sixty-three ICF categories out of 90 ICF categories contained in the Comprehensive ICF Core Set for Vocational Rehabilitation were reported by the patients. Forty-two additional categories that are not covered in the Comprehensive ICF Core Set for Vocational Rehabilitation were found but adding the health condition-specific ICF Core Set for SCI in long-term context, only 11 categories were not covered. The existing version of the Comprehensive ICF Core Set for Vocational Rehabilitation was confirmed almost entirely by the focus groups to explore the vocational situation of patients with SCI. Implications for Rehabilitation Validation of the ICF Core Set for Vocational Rehabilitation as a useful tool to facilitate social reintegration and rehabilitation of patients

  6. Monoaminergic and catecholaminergic activation of the central pattern generator for locomotion following spinal cord injury Innovative therapeutic approaches

    Institute of Scientific and Technical Information of China (English)

    Pierre A.Guertin

    2009-01-01

    The development of secondary health complications following spinal cord injury has been increasingly recognized by healthcare professionals as a major concern.These problems most specifically affect complete or near-complete spinal cord injury patients (e.g.,those with minimal mobility),who are not typically rehabilitated with treadmill training approaches,because motor control and leg movements are largely impaired.However,recent pharmaceutical advances in central pattern generator activation may provide new therapeutic hopes for these spinal cord injury patients.This article provides a comprehensive overview,for the non-specialist,of the most recent advances in this field.

  7. Incidence and predictors of contracture after spinal cord injury--a prospective cohort study.

    Science.gov (United States)

    Diong, J; Harvey, L A; Kwah, L K; Eyles, J; Ling, M J; Ben, M; Herbert, R D

    2012-08-01

    Prospective cohort study. To determine incidence of contracture and develop prediction models to identify patients susceptible to contracture after spinal cord injury. Two Sydney spinal cord injury units. A total of 92 consecutive patients with acute spinal cord injury were assessed within 35 days of injury and 1 year later. Incidence of contracture at 1 year was measured in all major appendicular joints by categorizing range of motion on a 4-point scale (0-no contracture to 3-severe contracture), and in the wrist, elbow, hip and ankle by measuring range of motion at standardized torque. Multivariate models were developed to predict contracture at 1 year using age, neurological status, spasticity, pain and limb fracture recorded at the time of injury. At 1 year, 66% of participants developed at least one contracture (defined as ≥1 point deterioration on the 4-point scale). Incidence of contracture at each joint was: shoulder 43%, elbow and forearm 33%, wrist and hand 41%, hip 32%, knee 11% and ankle 40%. Incidence of contracture determined by standardized torque measures of range (defined as loss of ≥10 degrees) was: elbow 27%, wrist 26%, hip 23% and ankle 25%. Prediction models were statistically significant but lacked sufficient predictive accuracy to be clinically useful (R(2)≤31%). The incidence of contracture in major joints 1 year after spinal cord injury ranges from 11-43%. The ankle, wrist and shoulder are most commonly affected. It is difficult to accurately predict those susceptible to contracture soon after injury.

  8. Stem cell-based therapies for spinal cord injury.

    NARCIS (Netherlands)

    Nandoe, R.D.S.; Hurtado, A.; Bartels, R.H.M.A.; Grotenhuis, A.; Oudega, M.

    2009-01-01

    Spinal cord injury (SCI) results in loss of nervous tissue and consequently loss of motor and sensory function. There is no treatment available that restores the injury-induced loss of function to a degree that an independent life can be guaranteed. Transplantation of stem cells or progenitors may s

  9. Reducing synuclein accumulation improves neuronal survival after spinal cord injury

    Science.gov (United States)

    Fogerson, Stephanie M.; van Brummen, Alexandra J.; Busch, David J.; Allen, Scott R.; Roychaudhuri, Robin; Banks, Susan M. L.; Klärner, Frank-Gerrit; Schrader, Thomas; Bitan, Gal; Morgan, Jennifer R.

    2016-01-01

    Spinal cord injury causes neuronal death, limiting subsequent regeneration and recovery. Thus, there is a need to develop strategies for improving neuronal survival after injury. Relative to our understanding of axon regeneration, comparatively little is known about the mechanisms that promote the survival of damaged neurons. To address this, we took advantage of lamprey giant reticulospinal neurons whose large size permits detailed examination of post-injury molecular responses at the level of individual, identified cells. We report here that spinal cord injury caused a select subset of giant reticulospinal neurons to accumulate synuclein, a synaptic vesicle-associated protein best known for its atypical aggregation and causal role in neurodegeneration in Parkinson’s and other diseases. Post-injury synuclein accumulation took the form of punctate aggregates throughout the somata and occurred selectively in dying neurons, but not in those that survived. In contrast, another synaptic vesicle protein, synaptotagmin, did not accumulate in response to injury. We further show that the post-injury synuclein accumulation was greatly attenuated after single dose application of either the “molecular tweezer” inhibitor, CLR01, or a translation-blocking synuclein morpholino. Consequently, reduction of synuclein accumulation not only improved neuronal survival, but also increased the number of axons in the spinal cord proximal and distal to the lesion. This study is the first to reveal that reducing synuclein accumulation is a novel strategy for improving neuronal survival after spinal cord injury. PMID:26854933

  10. The Effect of Injury-Related Characteristics on Changes in Mari¬tal Status after Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Effat MERGHATI KHOI

    2015-10-01

    Full Text Available Background: Spinal cord injury (SCI imposes a significant burden on the social and marital life. Here, we assessed the divorce rate and changes in marital status among a sample of Iranian individuals with SCI.Methods: Referred patients to Brain and Spinal Cord Injury Research Center were invited to participate in this cross-sectional investigation. The Main exclusion criteria were coincidental brain injury, history of chronic diseases before SCI and substance use. Demographic characteristics (including age, gender, educational level, marital status before and after injury and duration of marriage and Injury characteristics (level of the injury, American spinal injury association (ASIA scale and Spinal cord independence measure III (SCIM were collected.Results: Total of 241 subjects with SCI participated in this investigation (164 (68% male and 77 (32% female. Among men, 16.5% [95% CI: 10.81%-22.18%] and among women 18.2% [95% CI: 9.58%-26.81%] got divorced after injury. Duration of marriage before injury was significantly related to lower divorce rate (P< 0.001 and 0.016 in men and women, respectively. Injury characteristics had no relationship with marital longevity. Age was a protective factor against marital dissolution only in men (P< 0.004.Conclusion: Our study revealed the divorce rate of 17% [95% CI: 13%-20.9%] after SCI in a sample of Iranian population. The protective influence of age in maintenance of marriage was only detected in men, which proposes existence of a sexual polymorphism in the role of age. Divorce rate was similar between two genders and injury characteristics were not related to divorce rate as well. Keywords: Marital status, Spinal cord injury, Divorce, Iran

  11. Prognostic study of acute cervical cord injury by plain and enhanced MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Mori, Eiji; Shiba, Keiichiro; Ueda, Takayoshi [Spinal Injuries Center, Iizuka, Fukuoka (Japan)] [and others

    1995-09-01

    Ninety-six patients with cervical cord injury underwent MR imaging 10 days (early phase) and 2 weeks after injury to predict the pathophysiology of injury at 2 weeks. The subjects were divided into the following 3 groups based on the findings of T2-weighted images at the early phase: Group I, patients showing a low signal intensity area in the injured spinal cord; Group II, patients showing only a high intensity area; Group III, patients showing no changes in the signal intensity. The images taken at 2 weeks after injury were classified into the following 3 types: type R, images with a rim-enhanced site in the periphery of the injured spinal cord; type NR, images with no rim-enhanced site; type N, images with no enhanced area. Most of the Group I patients (more than 80%) had palsy, and all Group III patients had paresis. All type R patients had palsy, and all type N patients had paresis. The difference in the morphology of contrast site was useful in differentiating palsy and paresis in type NR cases in the Group II. Although it is possible to predict the pathophysiology of injury based on the findings of T2-weighted images taken at early phase, images taken at 2 weeks after injury provided more accurate prognosis. (S.Y.).

  12. Delayed acute spinal cord injury following intracranial gunshot trauma: case report.

    Science.gov (United States)

    Cheng, Jason S; Richardson, R Mark; Gean, Alisa D; Stiver, Shirley I

    2012-04-01

    The authors report the case of a patient who presented with a hoarse voice and left hemiparesis following a gunshot injury with trajectory entering the left scapula, traversing the suboccipital bone, and coming to rest in the right lateral medullary cistern. Following recovery from the hemiparesis, abrupt quadriparesis occurred coincident with fall of the bullet into the anterior spinal canal. The bullet was retrieved following a C-2 and C-3 laminectomy, and postoperative MR imaging confirmed signal change in the cord at the level where the bullet had lodged. The patient then made a good neurological recovery. Bullets can fall from the posterior fossa with sufficient momentum to cause an acute spinal cord injury. Consideration for craniotomy and bullet retrieval should be given to large bullets lying in the CSF spaces of the posterior fossa as they pose risk for acute spinal cord injury.

  13. Spinal cord injuries due to close combat weapons.

    Science.gov (United States)

    Fares, Youssef H; Fares, Jawad Y; Gebeily, Souheil E; Khazim, Rabi M

    2013-10-01

    A 17-year-old patient was aggressively attacked and stabbed in the dorsal region of his back by a knife. He was admitted to the emergency room of the Hammoud Hospital University Medical Center, Saida, Lebanon lying in the prone position. The neurological examination revealed that the stabbing object was fixed at the dorsal spine level at the T-7 level, where it was inserted inside the vertebral body. Luckily, the blade of the knife was parallel to the nervous tracts of the spinal cord; thus, he showed no neurological deficits. This case provides an overview of how neurosurgical principles can be applied to trauma patients with spine injuries due to close combat weapons.

  14. Urinary tract infections in special populations: diabetes, renal transplant, HIV infection, and spinal cord injury.

    Science.gov (United States)

    Nicolle, Lindsay E

    2014-03-01

    Some populations have unique considerations relevant to complicated urinary tract infection. For patients with diabetes, renal transplant, HIV infection, and spinal cord injuries, approaches to management, including diagnosis and treatment, are generally similar to other patients with complicated urinary tract infection. In addition, there is no evidence that treatment of asymptomatic bacteriuria leads to improved outcomes.

  15. Intraspinal penetrating stab injury to the middle thoracic spinal cord with no neurologic deficit.

    Science.gov (United States)

    Li, Xinning; Curry, Emily J; Blais, Micah; Ma, Richard; Sungarian, Arno S

    2012-05-01

    The annual incidence of traumatic spinal cord injury worldwide is estimated to be 35 patients per million. Nonmissile penetrating spinal injuries most commonly occur in the thoracic region, and the majority has neurologic deficits on admission. The management of patients who lack neurologic deficits is controversial due to the risk of neurologic status alteration intraoperatively. However, failure to intervene increases the risk of infection, delayed onset of neurologic deficits, and worsening functional outcome.A 17-year-old boy presented with an intradural T7-T8 knife penetration injury to the spinal cord with no neurologic deficit. Rapid surgical intervention was critical because the knife was lodged between the 2 hemispheres of the spinal cord. The patient was intubated in the lateral position, transferred to the prone position on a Jackson table, and underwent surgical decompression with laminectomy 1 level above and below the injury site, removal of the knife blade in the original path of trajectory, and repair of the dural tear with a collagen matrix. The patient sustained no neurologic sequelae from the penetrating knife injury. He was able to ambulate at discharge and had no complications. To our knowledge, this is the only report of a patient with intradural spinal cord penetration by a foreign object (knife blade) presenting with a normal neurologic preoperative examination that persisted throughout the course of postoperative care.

  16. Olfactory ensheathing cell transplantation improves sympathetic skin responses in chronic spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    Zuncheng Zheng; Guifeng Liu; Yuexia Chen; Shugang Wei

    2013-01-01

    Forty-three patients with chronic spinal cord injury for over 6 months were transplanted with bryonic olfactory ensheathing cells, 2-4 × 106, into multiple sites in the injured area under the sur-gical microscope. The sympathetic skin response in patients was measured with an electromyo-graphy/evoked potential instrument 1 day before transplantation and 3-8 weeks after trans-tion. Spinal nerve function of patients was assessed using the American Spinal Injury Association impairment scale. The sympathetic skin response was elicited in 32 cases before olfactory en-sheathing celltransplantation, while it was observed in 34 cases after transplantation. tantly, sympathetic skin response latency decreased significantly and amplitude increased cantly after transplantation. Transplantation of olfactory ensheathing cells also improved American Spinal Injury Association scores for movement, pain and light touch. Our findings indicate that factory ensheathing celltransplantation improves motor, sensory and autonomic nerve functions in patients with chronic spinal cord injury.

  17. Fractionated and single-dose radiotherapy for heterotopic bone formation in patients with spinal cord injury. A phase-I/II study

    Energy Technology Data Exchange (ETDEWEB)

    Sautter-Bihl, M.L.; Hueltenschmidt, B.; Liebermeister, E. [Staedtisches Klinikum Karlsruhe (Germany). Klinik fuer Strahlentherapie und Nuklearmedizin; Nanassy, A. [Klinikum Karlsbad-Langensteinbach (Germany). Orthopaedie I

    2001-04-01

    Background: Heterotopic ossification occur in about 20% of patients with spinal cord injury and may seriously compromise the rehabilitation process. Aim of the present study was to evaluate if radiotherapy administered early in the course of the disease prevents the manifestation of heterotopic ossification and if in patients whose bone formations have been resected recurrence can be avoided. Patients and Methods: 52 patients (44 males, eight females, median age 33 years) and 75 joints were irradiated between December 1989 and March 2000. 49 patients (70 joints, 65 hips, three knees, one shoulder, one elbow) were evaluable. Median follow-up was 11 months. In 58 joints radiotherapy was performed as a primary treatment in the inflammatory phase of soft tissue swelling that precedes manifestation of heterotopic ossifications. Twelve joints were treated after resection of manifest heterotopic bone, two patients had primary and postoperative irradiation in different joints. The dose was 10 Gy in single fractions of 2-2,5 Gy in 34 joints and 7.5-20 Gy in six joints. >From July 1996 on, 30 joints received single-dose irradiation with 8 Gy. Results: 50/70 joints (71%) remained free from progression. This was the case for 47/65 (72%) hips, whereas in 18 hips (27%) the Brooker score increased for 1-2 grades and caused a moderate decrease of mobility in five joints. Out of the other five joints, two knees developed progression. No relevant side effects occurred. Conclusion: The present results suggest that radiotherapy is an effective local treatment option for spinal cord injured patients with heterotopic ossifications. (orig.) [German] Hintergrund: Heterotope Ossifikationen treten bei bis zu 20% von Patienten mit verletzungsbedingter Querschnittslaehmung auf und koennen die Rehabilitation erheblich erschweren. Ziel der vorliegenden Studie war zu evaluieren, ob durch eine primaer im Anfangsstadium der Erkrankung eingesetzte Strahlentherapie die Manifestation heterotoper

  18. Spinal cord injuries from road traffic crashes in southeastern Iran

    Institute of Scientific and Technical Information of China (English)

    Mohammad R Rasouli; Mohsen Nouri; Vafa Rahimi-Movaghar

    2007-01-01

    Objective: To analyze the data of patients with spinal cord injury (SCI) induced by road traffic crashes in southeastern Iran for better understanding the pattern of these injuries and therefore for better designing health system planning.Methods: In this historical cohort study, the patients who had been transferred to Level I trauma center in southeastern Iran due to road traffic accidents with radiographic documented SCI were evaluated.Results: Among 64 patients with SCI, 38 patients (59.4%, 36 males and 2 females, aged 27.42 years ± 9.44 years on average) were injured by road traffic accidents.Car and motorcycle accidents were responsible for 26 cases (68.4%) and 12 cases (31.6%), respectively. And 31 patients (81. 6%) had complete SCI. Conus medularis (T12-L2) was the most affected level.Conclusions: Results are discussed in terms of preventive measures, specifically those concerning the use of restraint and helmet and driving behavior. This study should be extended nationally to gain a larger case series so that the SCI risk of particular vehicle configurations,considering other crash factors, can be more precisely quantified and the characteristics for low occurrence of SCI can be more precisely identified.

  19. Traumatic spinal cord injury in the United States, 1993-2012.

    Science.gov (United States)

    Jain, Nitin B; Ayers, Gregory D; Peterson, Emily N; Harris, Mitchel B; Morse, Leslie; O'Connor, Kevin C; Garshick, Eric

    2015-06-09

    Acute traumatic spinal cord injury results in disability and use of health care resources, yet data on contemporary national trends of traumatic spinal cord injury incidence and etiology are limited. To assess trends in acute traumatic spinal cord injury incidence, etiology, mortality, and associated surgical procedures in the United States from 1993 to 2012. Analysis of survey data from the US Nationwide Inpatient Sample databases for 1993-2012, including a total of 63,109 patients with acute traumatic spinal cord injury. Age- and sex-stratified incidence of acute traumatic spinal cord injury; trends in etiology and in-hospital mortality of acute traumatic spinal cord injury. In 1993, the estimated incidence of acute spinal cord injury was 53 cases (95% CI, 52-54 cases) per 1 million persons based on 2659 actual cases. In 2012, the estimated incidence was 54 cases (95% CI, 53-55 cases) per 1 million population based on 3393 cases (average annual percentage change, 0.2%; 95% CI, -0.5% to 0.9%). Incidence rates among the younger male population declined from 1993 to 2012: for age 16 to 24 years, from 144 cases/million (2405 cases) to 87 cases/million (1770 cases) (average annual percentage change, -2.5%; 95% CI, -3.3% to -1.8%); for age 25 to 44 years, from 96 cases/million (3959 cases) to 71 cases/million persons (2930 cases), (average annual percentage change, -1.2%; 95% CI, -2.1% to -0.3%). A high rate of increase was observed in men aged 65 to 74 years (from 84 cases/million in 1993 [695 cases] to 131 cases/million [1465 cases]; average annual percentage change, 2.7%; 95% CI, 2.0%-3.5%). The percentage of spinal cord injury associated with falls increased significantly from 28% (95% CI, 26%-30%) in 1997-2000 to 66% (95% CI, 64%-68%) in 2010-2012 in those aged 65 years or older (P spinal cord injury remained relatively stable but, reflecting an increasing population, the total number of cases increased. The largest increase in incidence was observed in older

  20. Spinal cord injury and substance use: a systematic review.

    Science.gov (United States)

    Lusilla-Palacios, P; Castellano-Tejedor, Carmina

    2015-12-15

    The objective of this study was to review recent findings about the prevalence of substance use (SU) and substance use disorders (SUD), and to discuss the related impact on health in spinal cord injury (SCI) population. For this purpose, computer-aided searches of MEDLINE (PubMed) and the Cochrane Library were conducted. From an initial pool of 59 articles, 52 met the inclusion criteria. Most of the studies referred to alcohol and tobacco and only a few studies reported on other substances. Study designs were mainly cross-sectional and descriptive, with scarce intervention and longitudinal studies.  Although a high prevalence of post-injury SU has been documented among SCI patients, limited research exists on pre-injury SU and on longitudinal studies. Moreover, when exploring SUD, it has not been systematically studied in accordance with CIE or DSM criteria. Alcohol appears to be the most consumed substance among this population. Additionally, those patients with SU have shown poorer outcomes in different health indicators. Therefore, more insight is required to increase scientific knowledge in this field and to recommend tailored preventive interventions and research priorities in relation to this population.

  1. Cervical spinal cord injury during cerebral angiography with MRI confirmation: case report

    Energy Technology Data Exchange (ETDEWEB)

    Bejjani, G.K.; Rizkallah, R.G.; Tzortidis, F. [Department of Neurosurgery, George Washington University Medical Center, Washington, DC (United States); Mark, A.S. [Department of Neuroradiology, Washington Hospital Center, Washington, DC (United States)

    1998-01-01

    We report the first case of MRI-documented cervical spinal cord injury during cerebral angiography. A 54-year-old woman underwent an angiogram for subarachnoid hemorrhage. Her head was secured in a plastic head-holder. At the end of the procedure, she was found to have a left hemiparesis. MRI revealed high signal in the cervical spinal cord. The etiology may have been mechanical due to patient positioning, or toxic, from contrast medium injection in the vessels feeding the spinal cord, or a combination of both. (orig.) With 3 figs., 26 refs.

  2. A Multicenter, Randomized Controlled Trial of Cerebrospinal Fluid Drainage in Acute Spinal Cord Injury

    Science.gov (United States)

    2015-10-01

    Injury PRINCIPAL INVESTIGATOR: Nicholas Theodore, MD CONTRACTING ORGANIZATION: Dignity Health San Francisco, CA 94107-1773 REPORT DATE: October 2015...TASK NUMBER E-Mail: Nicholas.Theodore@bnaneuro.net 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Dignity Health AND ADDRESS...patients aims to reduce cell death and axonal damage leading to improved neurological function in patients. 2. KEYWORDS acute spinal cord injury

  3. Therapeutic Stimulation for Restoration of Function After Spinal Cord Injury.

    Science.gov (United States)

    Ievins, Aiva; Moritz, Chet T

    2017-09-01

    Paralysis due to spinal cord injury can severely limit motor function and independence. This review summarizes different approaches to electrical stimulation of the spinal cord designed to restore motor function, with a brief discussion of their origins and the current understanding of their mechanisms of action. Spinal stimulation leads to impressive improvements in motor function along with some benefits to autonomic functions such as bladder control. Nonetheless, the precise mechanisms underlying these improvements and the optimal spinal stimulation approaches for restoration of motor function are largely unknown. Finally, spinal stimulation may augment other therapies that address the molecular and cellular environment of the injured spinal cord. The fact that several stimulation approaches are now leading to substantial and durable improvements in function following spinal cord injury provides a new perspectives on the previously "incurable" condition of paralysis. Copyright © 2017 the American Physiological Society.

  4. An analysis of complications and risk factors in senile resident patients with traumatic spinal cord injuries%老年外伤性脊髓损伤住院患者并发症及危险因素分析

    Institute of Scientific and Technical Information of China (English)

    陈华; 于铁强; 王国强; 左玉明; 王月光

    2015-01-01

    Objective To investigate the complications and risk factors in senile resident patients with traumatic spinal cord injuries.Methods From January 1, 2007 to December 31, 2011, senile resident patients with traumatic spinal cord injuries were adopted, whose age was more than 60 years old. Their age, gender, spinal cord injury level, American Spinal Injury Association ( ASIA ) scores and complications were retrospectively reviewed. Results There were 136 patients in total. Complications occurred in 39 patients, including respiratory complications in 20 patients, cardiovascular complications in 7 patients, digestive complications in 6 patients, urologic complications in 5 patients, bedsores in 5 patients, infections in 1 patient and spasticity in the lower limbs in 1 patients. The complications with more than 2 kinds of systems involved were found in 8 patients. The sensory score, motor score and surgery or not were correlated to the complications (P<0.05 ). The motor score and surgery or not are considered as the independent risk factors of spinal cord injuries in senile resident patients. A negative correlation existed between the motor score and the complications (P<0.05 ), and a positive correlation was noticed between the surgery or not and the complications (P<0.05 ).Conclusions The most common complications originate from the respiratory system in senile patients with spinal cord injuries, and the complications with multiple systems involved are frequently noticed. More serious the injuries are, higher the incidence rate of complications will be. The incidence rate of early complications will be increased due to the surgery.%目的:探讨老年外伤性脊髓损伤住院患者的并发症及其危险因素。方法回顾性分析2007年1月1日至2011年12月31日,就诊于我院的60岁以上的外伤性脊髓损伤住院患者的年龄、性别、脊髓损伤水平及美国脊髓损伤协会(Americanspinalinjuryassociation,ASIA

  5. Knowledge, attitudes and practices of medical staff towards obesity management in patients with spinal cord injuries: an International survey of four western European countries.

    Science.gov (United States)

    Wong, S; van Middendorp, J; Belci, M; van Nes, I; Roels, E; Smith, É; Hirani, S P; Forbes, A

    2015-01-01

    To (1) examine the opinions of medical staff working in spinal cord injury (SCI) centres (SCICs); (2) evaluate their knowledge, attitudes and practices towards obesity prevention and management; (3) report the number of beds and dietitians available at each SCIC. A 37-item questionnaire was sent to 23 SCICs in the UK, the Netherlands, Belgium and the Republic of Ireland between September 2012 and January 2013. Eighteen SCICs returned the questionnaires for analysis. All respondents stated that they had an interest in obesity treatment but only 2.3% of the respondents received training in obesity management. Sixty-one percent of staff did not consider body mass index (BMI) to be appropriate for use in SCI patients and subsequently less than half of the respondents use BMI routinely. The majority of respondents reported that they are confident in dealing with overweight (74.5%) and obese (66.1%) SCI adults, less than half (44.1%) are confident in treating overweight and obese SCI children. Respondents also indicated the need for nationally adopted guidelines and a lack of physical activity provision. There were 17.5 whole-time equivalent (WTE) dietitians recorded in 22 SCICs, equivalent to 47.8 beds per WTE dietitians (range 10-420). Non-UK SCIC dietitians are significantly better resourced than in UK SCICs (beds per WTE dietitian: 36 vs 124, P=0.035). Medical staff expressed the need to participate in obesity prevention and management. Appropriate training should be considered for all medical staff and the development of specific weight management guidelines and dietetic provision should be considered.

  6. Cannabis use in persons with traumatic spinal cord injury in Denmark

    DEFF Research Database (Denmark)

    Andresen, Sven Robert; Biering-Sørensen, Fin; Hagen, Ellen Merete

    2017-01-01

    OBJECTIVE: To evaluate recreational and medical cannabis use in individuals with traumatic spinal cord injury, including reasons and predictors for use, perceived benefits and negative consequences. DESIGN: Cross-sectional survey in Denmark. METHODS: A 35-item questionnaire was sent to 1,101 pati......OBJECTIVE: To evaluate recreational and medical cannabis use in individuals with traumatic spinal cord injury, including reasons and predictors for use, perceived benefits and negative consequences. DESIGN: Cross-sectional survey in Denmark. METHODS: A 35-item questionnaire was sent to 1......,101 patients with spinal cord injury who had been in contact with a rehabilitation centre between 1990 and 2012. RESULTS: A total of 537 participants completed the questionnaire. Of these, 36% had tried cannabis at least once and 9% were current users. Of current users, 79% had started to use cannabis before...... their spinal cord injury. The main reason for use was pleasure, but 65% used cannabis partly for spinal cord injury-related consequences and 59% reported at least good effect on pain and spasticity. Negative consequences of use were primarily inertia and feeling quiet/subdued. Lower age, living in rural areas...

  7. Successful spinal cord stimulation for neuropathic below-level spinal cord injury pain following complete paraplegia: a case report.

    Science.gov (United States)

    Reck, Tim A; Landmann, Gunther

    2017-01-01

    Neuropathic pain is common in patients with spinal cord injury (SCI) and often difficult to treat. We report a case where epidural spinal cord stimulation (SCS) below the level of injury has been successfully applied in a patient with a complete spinal cord lesion. A 53-year-old female presented with neuropathic below-level SCI pain of both lower legs and feet due to complete SCI below T5. Time and pain duration since injury was 2 years. Pain intensity was reported on numeric rating scale with an average of 7/10 (0 meaning no pain, 10 meaning the worst imaginable pain), but also with about 8-10 pain attacks during the day with an intensity of 9/10, which lasted between some minutes and half an hour. SCS was applied below the level of injury at-level T11-L1. After a successful 2 weeks testing period the pulse generator has been implanted permanently with a burst-stimulation pattern. The average pain was reduced to a bearable intensity of 4/10, in addition attacks could be reduced both in frequency and in intensity. This effects lasted for at least three months of follow-up. Even in case of complete SCI, SCS might be effective. Mechanisms of pain relief remain unclear. A modulation of suggested residual spinothalamic tract function may play a role. Further investigation has to be carried out to support this theory.

  8. Case study of Oriental Medicine Treatment with Mae-sun therapy of the spinal cord injury due to lumbar burst fracture

    OpenAIRE

    Kwon Gi-sun; Park Jung-ah; Noh Ju-hwan; Kim Cheol-hong

    2010-01-01

    Objective : Traumatic lumbar burst fracture causes significant spinal cord injury. This report is intended to estimate the efficacy using oriental treatment on a patient with lumbar burst fracture and spinal cord injury. Methods : From 21th December, 2009 to 5th February, 2010, 1 female inpatient diagnosed with lumbar burst fracture and spinal cord injury was treated with general oriental medicine therapy : mae-sun therapy ; acupuncture ; moxibustion ; pharmacopuncture ; physical therapy a...

  9. Forty-five-year follow-up on the renal function after spinal cord injury

    DEFF Research Database (Denmark)

    Elmelund, M; Oturai, P S; Toson, B;

    2016-01-01

    STUDY DESIGN: Retrospective chart review. OBJECTIVES: To investigate the extent of renal deterioration in patients with spinal cord injury (SCI) and to identify risk indicators associated with renal deterioration. SETTING: Clinic for Spinal Cord Injuries, Rigshospitalet, Hornbæk, Denmark. METHODS......: This study included 116 patients admitted to our clinic with a traumatic SCI sustained between 1956 and 1975. Results from renography and (51)Cr-EDTA plasma clearance were collected from medical records from time of injury until 2012, and the occurrence of renal deterioration was analysed by cumulative...... increased the risk of moderate and severe renal deterioration. CONCLUSION: Renal deterioration occurs at any time after injury, suggesting that lifelong follow-up examinations of the renal function are important, especially in patients with dilatation of UUT and/or renal/ureter stones....

  10. 50 years follow-up on plasma creatinine levels after spinal cord injury

    DEFF Research Database (Denmark)

    Elmelund, Marlene; Oturai, P S; Biering-Sørensen, F

    2014-01-01

    STUDY DESIGN: Retrospective chart review. OBJECTIVES: To investigate the role of plasma creatinine (p-creatinine) in monitoring renal deterioration in patients up to 50 years after spinal cord injury (SCI). SETTING: The Clinic for Spinal Cord Injuries, Rigshospitalet, Denmark. METHODS: A total...... of 119 patients with a traumatic SCI during the years 1944-1975 were included in the study. P-creatinine measurements, results from renography and glomerular filtration rate (GFR) measured with 51Cr-EDTA clearance were obtained from medical records and analyzed using a linear mixed model and linear...... regression analyses. RESULTS: When compared with median p-creatinine level in the first 5-year period after injury, the level of p-creatinine was stable throughout the first 30 years and decreased significantly after the 30th until 45th year post injury. Only patients with a functional distribution outside...

  11. Severe, Protracted Spasm of Urinary Bladder and Autonomic Dysreflexia Caused by Changing the Suprapubic Catheter in a Cervical Spinal Cord Injury Patient: Treatment by a Bolus Dose and Increased Total Daily Dose of Intrathecal Baclofen

    Science.gov (United States)

    Vaidyanathan, Subramanian; Oo, Tun; Soni, Bakul M.; Hughes, Peter L.; Singh, Gurpreet

    2016-01-01

    BACKGROUND Intrathecal administration of baclofen by implanted pump reduces rigidity and muscle spasms. Its use specifically to control bladder spasms has not been reported. CASE REPORT A tetraplegic patient developed severe, protracted, bladder spasms, abdominal muscles spasms, and high blood pressure after change of suprapubic catheter; nifedipine, diazepam, and paracetamol did not control spasms; bolus dose of baclofen intrathecally produced prompt relief via baclofen pump. CONCLUSION Severe, protracted bladder spasms, abdominal muscles spasms, and autonomic dysreflexia, induced by change of suprapubic catheter in a spinal cord injury patient, were treated successfully by a bolus dose and increased total daily dose of intrathecal baclofen. PMID:28008298

  12. Group therapy utilization in inpatient spinal cord injury rehabilitation.

    Science.gov (United States)

    Zanca, Jeanne M; Dijkers, Marcel P; Hsieh, Ching-Hui; Heinemann, Allen W; Horn, Susan D; Smout, Randall J; Backus, Deborah

    2013-04-01

    To describe group therapy utilization in spinal cord injury (SCI) inpatient rehabilitation. Prospective observational study. Six inpatient rehabilitation facilities. Patients (N=1376) receiving initial rehabilitation after traumatic SCI. Not applicable. Time spent in group versus individual therapy for physical therapy (PT), occupational therapy (OT), therapeutic recreation (TR), and psychology (PSY) therapies. The majority (98%) of patients participated in at least 1 group therapy session, with 83%, 81%, 80%, and 54% of patients receiving group PT, OT, TR, and PSY, respectively. On average, 24% of treatment sessions and 27% of treatment time was provided in group sessions, with TR providing the greatest percent of its time in groups. Group therapy time and time spent in specific activities varied among patient subgroups with different injury characteristics. Group therapy time also varied widely among centers (range, 1.2-6.6h/wk). Across all injury subgroups, individual and group therapy hours per week were negatively correlated for OT and positively correlated for TR. Patient characteristics, clinician experience, and treatment center predicted 32% of variance in group hours per week. PT and OT strengthening/endurance interventions and TR outings were the most common group activities overall. While the majority of inpatient SCI rehabilitation consists of individual sessions, most patients participate in group therapy, which contributes significantly to total therapy time. Patterns of group utilization fit with functional expectations and clinical goals. A trade-off between group and individual therapy may occur in some disciplines. Utilization of group therapy varies widely among centers, and further study is needed to identify optimal patterns of group therapy utilization. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  13. THE VALUE OF CHINA NATIONAL SPINAL CORD INJURY DATABASE IN THE ANALYSIS OF PATIENTS WITH ACUTE SPINAL CORD INJURY%中国脊柱脊髓损伤数据库对急性脊髓损伤病人的分析价值

    Institute of Scientific and Technical Information of China (English)

    孙中仪; 陈伯华; 胡有谷; 马学晓; 岳斌

    2012-01-01

    目的 了解中国脊柱脊髓损伤数据库的优点.方法 采用中国脊柱脊髓损伤数据库,采用统一的调查表,采集35例病人的信息.结果 脊髓损伤男女性别比率为10.67∶1,平均年龄50.06岁,其中工人和农民共29例(82.85%).常见的致伤原因为交通事故和高处坠落(分别占44.00%和24.00%).骨折部位:颈段10例(28.57%),胸段6例(17.14%),胸腰段4例(11.43%).完全性损伤12例(34.29%),不完全性损伤23例(65.71%);按ASIA分级,脊髓功能分级主要以A级和D级为主,分别占34.29%和25.71%.35例病人中存在抑郁及创伤后应激障碍症状者分别为25例和17例.结论 通过中国脊髓损伤数据库,可以对急性脊髓损伤病人进行全方位的分析,了解急性脊髓损伤的发病特点,提高急性脊髓损伤疾病的预防水平.%Objective To understand the advantages of China spinal cord injury database. Methods Using CSCID and a unified questionnaire, the information of 35 patients was collected. Results The male female ratio of spinal cord injury was 10. 67 : 1, with a mean age of 50. 06 years, of whom, 29 were workers or peasants (82. 58%). The commonly seen causes were falling from a height and traffic accidents, accounting for 44. 00% and 24. 00%, respectively. Fracture sites: cervical segments, 10 cases (28. 57%), thoracic six (17. 14%), and thoracolumbar four (11. 43%). Complete injury was 12 cases (65. 71%), incomplete injury 23 (65. 71%). According to ASIA classification, function of the spinal cord was mainly A and D, accounting for 34, 29% and 25. 71% respectively. Of the 35 patients who had depression or post-traumatic stress disorder symptoms was 25 cases and 17 cases, respectively. Conclusion Adopting China national spinal cord injury database, it is possible to make a complete a-nalysis for patients with acute spinal injury, understand the characteristics of the condition and elevate the level of its prevention.

  14. Problems of sexual function after spinal cord injury.

    Science.gov (United States)

    Elliott, Stacy L

    2006-01-01

    Sex is a legitimate and fundamental need in humans. Substantial changes to both the autonomic and somatic nervous system occur after spinal cord injury, and result in altered sexual function and fertility potential. This chapter provides a clinical overview of the main sexual and reproductive concerns and priorities men and women face after spinal cord injury. Besides genital functioning, other autonomic functions affect sexuality, such as bladder and bowel function, cardiovascular control and temperature regulation. These interlinked autonomic functions are presented in their impact on sexuality. The mind-body interaction and spinal feedback loops are discussed. It is proposed that human sexuality after spinal cord injury can be a model for investigating integrated autonomic function. Recent research on the measurement of cardiovascular parameters during vibrostimulation and ejaculation demonstrates the discordance between objective and subjective signs of autonomic dysreflexia. It is hoped that health care professionals and researchers will become motivated to attend to the unmet sexual health care needs of this population.

  15. MOTOmed运动训练对胸腰段脊髓损伤患者平衡功能的影响%Influence of MOTOmed training on balance function among patients with thoracolumbar spinal cord injuries patients

    Institute of Scientific and Technical Information of China (English)

    王玉英; 黄学英; 王丽华; 柳尧花

    2015-01-01

    Objective To study the effect of MOTOmed training on balance function among patients with thoracolumbar spinal cord injuries. Methods A total of 60 patients with thoracolumbar spinal cord injuries were selected by random number from January 2009 to August 2013, and they were divided into the observation group and the control group, with 30 cases in each group. The control group was given the conventional rehabilitation training, while the observation group was given the MOTOmed training. Before rehabilitation, and four courses and eight courses after rehabilitation training, the Berg Balance Scale ( BBS) was used to evaluate the balance function. Results Four courses and eight courses after rehabilitation training, the BBS score of the observation group were (27. 37 ± 5. 38) and (33. 30 ± 4. 90), which were significantly higher than those of the control group (t=7. 569, 7. 796, respectively;P<0. 01). Conclusions The MOTOmed training combined with routine rehabilitation training can improve the balance function in patients with thoracolumbar spinal cord injury.%目的:探讨 MOTOmed 运动训练对胸腰段脊髓损伤患者平衡功能的影响。方法将2009年1月—2013年8月60例胸腰段脊髓损伤患者按随机数字表法分为观察组和对照组各30例。对照组患者进行常规康复训练,观察组在常规康复训练的基础上进行MOTOmed训练。康复前及康复训练后4,8个疗程分别对采用Berg平衡量表(BBS)评定患者的平衡功能。结果康复训练4,8个疗程后,观察组患者BBS评分分别为(27.37±5.38),(33.30±4.90)分,均高于对照组,差异有统计学意义(t值分别为7.569,7.796;P<0.01)。结论 MOTOmed训练配合常规康复训练可较好地改善恢复期胸腰段脊髓损伤患者的平衡功能。

  16. International standards to document remaining autonomic function after spinal cord injury

    DEFF Research Database (Denmark)

    Krassioukov, Andrei; Biering-Sørensen, Fin; Donovan, William

    2012-01-01

    This is the first guideline describing the International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI). This guideline should be used as an adjunct to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) including...

  17. How Do I Deal with Depression and Adjustment to My Spinal Cord Injury?

    Medline Plus

    Full Text Available ... yourself with information on what a spinal cord injury is, and what it means in terms of ... thoughts. Depression is common in the spinal cord injury population -- affecting about 1 in 5 people. There ...

  18. How Do I Deal with Depression and Adjustment to My Spinal Cord Injury?

    Medline Plus

    Full Text Available ... yourself with information on what a spinal cord injury is, and what it means in terms of ... thoughts. Depression is common in the spinal cord injury population -- affecting about 1 in 5 people. There ...

  19. [Caregivers of individuals with spinal cord injury: caregiver burden].

    Science.gov (United States)

    Nogueira, Paula Cristina; Rabeh, Soraia Assad Nasbine; Caliri, Maria Helena Larcher; Haas, Vanderlei José

    2013-06-01

    A sectional study that had as its objectives to assess caregiver burden of for caregivers of individuals with Traumatic Spinal Cord Injury (TSCI) and its association with sociodemographic variables (age and sex), health status (self-reported illnesses) and caregiver characteristics (care time in years and daily hours of care). Data were collected by consultation of patient files and individual interviews at home using the instrument, Caregiver Burden Scale (CBScale). The results showed that most burden occurred in the domains: environment, disappointment and general strain. Presenting health problem (for all domains of the CBScale) and spending more hours per day in care (in the domain disappointment) represented the variables associated with burden. Studies of a more confirmatory nature than exploratory between the variables studied can be used to measure the burden obtained in this population of caregivers of individuals with TSCI.

  20. Noninvasive respiratory management of high level spinal cord injury.

    Science.gov (United States)

    Bach, John R

    2012-03-01

    This article describes noninvasive acute and long-term management of the respiratory muscle paralysis of high spinal cord injury (SCI). This includes full-setting, continuous ventilatory support by noninvasive intermittent positive pressure ventilation (NIV) to support inspiratory muscles and mechanically assisted coughing (MAC) to support inspiratory and expiratory muscles. The NIV and MAC can also be used to extubate or decannulate 'unweanable' patients with SCI, to prevent intercurrent respiratory tract infections from developing into pneumonia and acute respiratory failure (ARF), and to eliminate tracheostomy and resort to costly electrophrenic/diaphragm pacing (EPP/DP) for most ventilator users, while permitting glossopharyngeal breathing (GPB) for security in the event of ventilator failure.

  1. Kinesitherapy in treatment of 35 cases with spinal cord injury%运动疗法治疗脊髓损伤35例

    Institute of Scientific and Technical Information of China (English)

    王瑞生

    2002-01-01

    Background: It is significant how to reserve residual myodynamia of patients with spinal cord injury, increase the ability of self care and make them return to the family and society.We adopted kinesitherapy to treat 35 patients with spinal cord injury and reported the results as follows.

  2. The International Spinal Cord Injury Pain Basic Data Set

    DEFF Research Database (Denmark)

    Widerstrom-Noga, E.; Bryce, T.; Cardenas, D.D.

    2008-01-01

    Objective:To develop a basic pain data set (International Spinal Cord Injury Basic Pain Data Set, ISCIPDS:B) within the framework of the International spinal cord injury (SCI) data sets that would facilitate consistent collection and reporting of pain in the SCI population.Setting:International.M......Objective:To develop a basic pain data set (International Spinal Cord Injury Basic Pain Data Set, ISCIPDS:B) within the framework of the International spinal cord injury (SCI) data sets that would facilitate consistent collection and reporting of pain in the SCI population...... core questions about clinically relevant information concerning SCI-related pain that can be collected by health-care professionals with expertise in SCI in various clinical settings. The questions concern pain severity, physical and emotional function and include a pain-intensity rating, a pain...... classification and questions related to the temporal pattern of pain for each specific pain problem. The impact of pain on physical, social and emotional function, and sleep is evaluated for each pain.Spinal Cord (2008) 46, 818-823; doi:10.1038/sc.2008.64; published online 3 June 2008 Udgivelsesdato: 2008/12...

  3. Early protective effects of Iloprost after experimental spinal cord injury.

    Science.gov (United States)

    Attar, A; Tuna, H; Sargon, M F; Yüceer, N; Türker, R K; Egemen, N

    1998-06-01

    This investigation was undertaken to study the early protective effects of Iloprost, a stable analogue of prostacyclin, after spinal cord injury in rabbit. Sixteen adult male rabbits (New Zealand Albino) were injured by application of epidural aneurysm clip. Eight rabbits received an intravenous (i.v.) infusion of 30 micrograms kg-1 Iloprost, and eight rabbits received an infusion of saline (SF). Treatment with Iloprost started immediately after spinal cord injury and continued for one hour. Evoked potentials were recorded for each rabbit at one, 15, and 60 minutes after the spinal cord injury. Twenty-four hours later, all the rabbits were deeply anesthetized and spinal cords were removed for histopathological examinations. There was no meaningful statistical difference between cortical somatosensorial evoked potentials (CSEP) of the saline and Iloprost group. However, light and electron microscopic studies showed that the Iloprost treated group had moderate protection of myelin and axons; and limited edema. These results suggest that intravenous Iloprost treatment after spinal cord injury has a highly protective effect without any side effects.

  4. Peripheral nerve grafts support regeneration after spinal cord injury.

    Science.gov (United States)

    Côté, Marie-Pascale; Amin, Arthi A; Tom, Veronica J; Houle, John D

    2011-04-01

    Traumatic insults to the spinal cord induce both immediate mechanical damage and subsequent tissue degeneration leading to a substantial physiological, biochemical, and functional reorganization of the spinal cord. Various spinal cord injury (SCI) models have shown the adaptive potential of the spinal cord and its limitations in the case of total or partial absence of supraspinal influence. Meaningful recovery of function after SCI will most likely result from a combination of therapeutic strategies, including neural tissue transplants, exogenous neurotrophic factors, elimination of inhibitory molecules, functional sensorimotor training, and/or electrical stimulation of paralyzed muscles or spinal circuits. Peripheral nerve grafts provide a growth-permissive substratum and local neurotrophic factors to enhance the regenerative effort of axotomized neurons when grafted into the site of injury. Regenerating axons can be directed via the peripheral nerve graft toward an appropriate target, but they fail to extend beyond the distal graft-host interface because of the deposition of growth inhibitors at the site of SCI. One method to facilitate the emergence of axons from a graft into the spinal cord is to digest the chondroitin sulfate proteoglycans that are associated with a glial scar. Importantly, regenerating axons that do exit the graft are capable of forming functional synaptic contacts. These results have been demonstrated in acute injury models in rats and cats and after a chronic injury in rats and have important implications for our continuing efforts to promote structural and functional repair after SCI.

  5. Powered exoskeletons for bipedal locomotion after spinal cord injury

    Science.gov (United States)

    Contreras-Vidal, Jose L.; Bhagat, Nikunj A.; Brantley, Justin; Cruz-Garza, Jesus G.; He, Yongtian; Manley, Quinn; Nakagome, Sho; Nathan, Kevin; Tan, Su H.; Zhu, Fangshi; Pons, Jose L.

    2016-06-01

    Objective. Powered exoskeletons promise to increase the quality of life of people with lower-body paralysis or weakened legs by assisting or restoring legged mobility while providing health benefits across multiple physiological systems. Here, a systematic review of the literature on powered exoskeletons addressed critical questions: What is the current evidence of clinical efficacy for lower-limb powered exoskeletons? What are the benefits and risks for individuals with spinal cord injury (SCI)? What are the levels of injury considered in such studies? What are their outcome measures? What are the opportunities for the next generation exoskeletons? Approach. A systematic search of online databases was performed to identify clinical trials and safety or efficacy studies with lower-limb powered exoskeletons for individuals with SCI. Twenty-two studies with eight powered exoskeletons thus selected, were analyzed based on the protocol design, subject demographics, study duration, and primary/secondary outcome measures for assessing exoskeleton's performance in SCI subjects. Main results. Findings show that the level of injury varies across studies, with T10 injuries being represented in 45.4% of the studies. A categorical breakdown of outcome measures revealed 63% of these measures were gait and ambulation related, followed by energy expenditure (16%), physiological improvements (13%), and usability and comfort (8%). Moreover, outcome measures varied across studies, and none had measures spanning every category, making comparisons difficult. Significance. This review of the literature shows that a majority of current studies focus on thoracic level injury as well as there is an emphasis on ambulatory-related primary outcome measures. Future research should: 1) develop criteria for optimal selection and training of patients most likely to benefit from this technology, 2) design multimodal gait intention detection systems that engage and empower the user, 3) develop

  6. Factors predicting publication of spinal cord injury trials registered on www.ClinicalTrials. gov.

    Science.gov (United States)

    DePasse, J Mason; Park, Sara; Eltorai, Adam E M; Daniels, Alan H

    2017-08-11

    Treatment options for spinal cord injuries are currently limited, but multiple clinical trials are underway for a variety of interventions, drugs, and devices. The Food and Drug Administration website www.ClinicalTrials.gov catalogues these trials and includes information on the status of the trial, date of initiation and completion, source of funding, and region. This investigation assesses the factors associated with publication and the publication rate of spinal cord injury trials. Retrospective analysis of publically available data on www.ClinicalTrials.gov. The www.ClinicalTrials.gov was queried for all trials on patients with spinal cord injury, and these trials were assessed for status, type of intervention, source of funding, and region. Multiple literature searches were performed on all completed trials to determine publication status. There were 626 studies identified concerning the treatment of patients with spinal cord injury, of which 250 (39.9%) were completed. Of these, only 119 (47.6%) were published. There was no significant difference in the rate of publication between regions (p> 0.16) or by study type (p> 0.29). However, trials that were funded by the NIH were more likely to be published than trials funded by industry (p= 0.01). The current publication rate of spinal cord injury trials is only 47.6%, though this rate is similar to the publication rate for trials in other fields. NIH-funded trials are significantly more likely to become published than industry-funded trials, which could indicate that some trials remain unpublished due to undesirable results. However, it is also likely that many trials on spinal cord injury yield negative results, as treatments are often ineffective.

  7. Use of the robot assisted gait therapy in rehabilitation of patients with stroke and spinal cord injury.

    Science.gov (United States)

    Sale, P; Franceschini, M; Waldner, A; Hesse, S

    2012-03-01

    Difficulty in walking is a major feature of neurological disease, and loss of mobility is the activity of daily living on which patients place the greatest value. The impact on patients is enormous, with negative ramifications on their participation in social, vocational, and recreational activities. In current clinical practice the gait restoration with robotic device is an integral part of rehabilitation program. Robot therapy involves the use of a robot exoskeleton device or end-effector device to help the patient retrain motor coordination by performing well-focused and carefully directed repetitive practice. The exoskeleton, as an assistive device, is also an external structural mechanism with joints and links corresponding to those of the human body. These robots use joint trajectories of the entire gait cycle and offer a uniform (more or less) stiff control along this trajectory. In this field the new powered exoskeleton ReWalk (Argo Medical Technologies Ltd) was developed to have an alternative mobility solution to the wheelchair and rehabilitation treatment for individuals with severe walking impairments, enabling them to stand, walk, ascend/descent stairs and more. The end-effector-based robot is a device with footplates placed on a double crank and rocker gear system. Alternatives to powered exoskeletons are devices that use movable footplates to which the patient's feet are attached. All devices include some form of body weight support. Prominent goals in the field include: developing implementable technologies that can be easily used by patients, therapists, and clinicians; enhancing the efficacy of clinician's therapies and increasing the ease of activities in the daily lives of patients.

  8. A Simple Radiological Technique for Demonstration of Incorrect Positioning of a Foley Catheter with Balloon Inflated in the Urethra of a Male Spinal Cord Injury Patient

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2006-01-01

    Full Text Available In a male patient with cervical spinal cord injury, the urinary bladder may go into spasm when a urethral catheter is removed and a new Foley catheter is inserted. Before the balloon is inflated, the spastic bladder may push the Foley catheter out or the catheter may slip out of a small-capacity bladder. An inexperienced health professional may inflate the balloon of a Foley catheter in the urethra without realizing that the balloon segment of the catheter is lying in the urethra instead of the urinary bladder. When a Foley balloon is inflated in the urethra, a tetraplegic patient is likely to develop autonomic dysreflexia. This is a medical emergency and requires urgent treatment. Before the incorrectly placed Foley catheter is removed, it is important to document whether the balloon has been inflated in the urinary bladder or not. The clinician should first use the always available tools of observation and palpation at the bedside without delays of transportation. A misplaced balloon will often be evident by a long catheter sign, indicating excessive catheter remaining outside the patient. Radiological diagnosis is not frequently required and, when needed, should employ the technique most readily available, which might be a body and pelvic CT without intravenous contrast. An alternative radiological technique to demonstrate the position of the balloon of the Foley catheter is described. Three milliliters of nonionic X-ray contrast medium, Ioversol (OPTIRAY 300, is injected through the side channel of the Foley catheter, which is used for inflating the balloon. Then, with a catheter-tip syringe, 30 ml of sterile Ioversol is injected through the main lumen of the Foley catheter. Immediately thereafter, an X-ray of the pelvis (including perineum is taken. By this technique, both the urinary bladder and balloon of the Foley catheter are visualized by the X-ray contrast medium. When a Foley catheter has been inserted correctly, the balloon of the

  9. Spinal cord injury following chiropractic manipulation to the neck.

    Science.gov (United States)

    Chakraverty, Julian; Curtis, Olivia; Hughes, Tom; Hourihan, Margaret

    2011-12-01

    Spinal cord injury is a rare complication of chiropractic treatment. This case report describes a 50-year-old man who developed neurological symptoms a few hours after manipulation (high velocity low amplitude [HVLA] technique) of the cervical spine. Magnetic resonance (MR) imaging of the cervical spine revealed intramedullary high signal at the C2/3 level of the right side of the cervical cord on the T2-weighted images. The potential mechanism of injury and causes of the radiological appearance are discussed.

  10. International urodynamic basic spinal cord injury data set

    DEFF Research Database (Denmark)

    Craggs, M.; Kennelly, M.; Schick, E.;

    2008-01-01

    OBJECTIVE: To create the International Urodynamic Basic Spinal Cord Injury (SCI) Data Set within the framework of the International SCI Data Sets. SETTING: International working group. METHODS: The draft of the data set was developed by a working group consisting of members appointed...... by the Neurourology Committee of the International Continence Society, the European Association of Urology, the American Spinal Injury Association (ASIA), the International Spinal Cord Society (ISCoS) and a representative of the Executive Committee of the International SCI Standards and Data Sets. The final version...

  11. International bowel function extended spinal cord injury data set

    DEFF Research Database (Denmark)

    Krogh, K; Perkash, I; Stiens, S A;

    2008-01-01

    STUDY DESIGN: International expert working group.Objective:To develop an International Bowel Function Extended Spinal Cord Injury (SCI) Data Set presenting a standardized format for the collection and reporting of an extended amount of information on bowel function. SETTING: Working group...... consisting of members appointed by the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS). METHODS: A draft prepared by the working group was reviewed by Executive Committee of the International SCI Standards and Data Sets and later by the ISCoS Scientific Committee...

  12. International bowel function basic spinal cord injury data set

    DEFF Research Database (Denmark)

    Krogh, K; Perkash, I; Stiens, S A;

    2008-01-01

    STUDY DESIGN: International expert working group. OBJECTIVE: To develop an International Bowel Function Basic Spinal Cord Injury (SCI) Data Set presenting a standardized format for the collection and reporting of a minimal amount of information on bowel function in daily practice or in research....... SETTING: Working group consisting of members appointed by the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS). METHODS: A draft prepared by the working group was reviewed by Executive Committee of the International SCI Standards and Data Sets, and later by ISCo...

  13. Exercise and sport for persons with spinal cord injury.

    Science.gov (United States)

    Martin Ginis, Kathleen A; Jörgensen, Sophie; Stapleton, Jessica

    2012-11-01

    This review article provides an overview of the evidence that links exercise and sports participation to physical and psychological well-being among people with spinal cord injury. Two aspects of physical well-being are examined, including the prevention of chronic disease and the promotion of physical fitness. Multiple aspects of psychosocial well-being are discussed, including mental health, social participation, and life satisfaction. The review concludes with future research recommendations and a discussion of challenges and opportunities for using exercise and sports to promote health and well-being among people living with spinal cord injury.

  14. Wheelchair Taijiquan for Mental Health of Patients with Spinal Cord Injury:A Case Study%"十式"轮椅太极拳对脊髓损伤患者心理健康的个案研究

    Institute of Scientific and Technical Information of China (English)

    金梅; 马丽娜; 齐晓英

    2012-01-01

    目的 观察"十式"轮椅太极拳对脊髓损伤患者心理健康的影响.方法 1 例42 岁男性脊髓损伤患者练习"十式"轮椅太极拳,每次90 min,每周3 次,共10 周.运用临床症状自评量表(SCL-90)分别在试验前、试验后10 周进行两次测试.结果 10 周后该患者的睡眠、饮食、躯体化因子、敌对、偏执、精神病性、强迫症状因子得到明显改善,人际关系敏感、抑郁、焦虑、恐怖因子也有所改善.结论 轮椅太极拳有利于改善脊髓损伤患者心理健康状况.%Objective To observe the effect ofWheelchair Taijiquan on menhd health of patient with spinal cord injury. Methods One 42-year-old male patient with spinal cord injury practiced wheelchair Taijiquan. 90 min everytime. 3 times a week for 10 weeks. SCL-90 was used to assess the relevant indicators before and 10 weeks after the experiment. Results 10 weeks after Wheelchair Taijiquan exercises, the patient improved in sleep quality, appetite and physical health, and the symptoms as antagonism, paranoid, psychosis and obsessive-compulsive disorder as well as intervening with interpersonal sensitivity, depression, anxiety and fear. Conclusion Wheelchair Taijiquan may facilliate to improve the mental health of patient with spinal cord injury.

  15. To Investigate the Effect of Home Care on the Quality of Life of Patients With Spinal Cord Injury%探讨家庭照护对脊髓损伤患者生活质量的影响

    Institute of Scientific and Technical Information of China (English)

    李琳琳

    2015-01-01

    目的:研究家庭照护对脊髓损伤患者生活质量的影响。方法选取我院60例脊髓损伤患者按照护理方法分为两组(各30例),观察组家庭照护,对照组常规护理措施。结果观察组患者护理后日常生活能力评分显著高于对照组和护理前,抑郁评分显著低于对照组患者和护理前,差异有显著性(P<0.05)。结论家庭照护可显著提高脊髓损伤患者生活质量,改善患者预后。%Objective To study the effect of home care on the quality of life of patients with spinal cord injury.Methods60 cases of spinal cord injury patients in our hospital were divided into two groups (30 cases), the observation group of family care, the control group of routine nursing measures.ResultsThe daily life ability score of the observation group were significantly higher than those in the control group and the nursing care, the depression score was significantly lower than the control group before and after nursing, the difference was significant (P<0.05).Conclusion Family care can significantly improve the quality of life of patients with spinal cord injury, improve the prognosis of patients.

  16. Brain activity on fMRI associated with urinary bladder filling in patients with a complete spinal cord injury

    DEFF Research Database (Denmark)

    Krhut, Jan; Tintera, Jaroslav; Bilkova, Karolina

    2017-01-01

    because of activation artifacts. In 8 of 12 patients, significant brain activity was observed during urinary bladder filling. We found significant activation clusters at the nucleus of the solitary tract (NTS) (3/8), parabrachial nucleus (PBN) (4/8), hypothalamus (4/8), thalamus (6/8), amygdala (7...

  17. Lower thoracic spinal cord injury without radiographic abnormality in an amateur rugby player.

    Science.gov (United States)

    Smith, Hannah K; Durnford, Andrew J; Sherlala, Khaled; Merriam, William F

    2012-10-26

    A 37-year-old man, amateur rugby player sustained a hyperextension injury to his lower thoracic spine during a scrum collapse. The patient developed extreme hyperpathia in the T10-12 dermatome, and parasthesia from T12 to S1 in the left lower limb. Medical Research Council grade 5 power was regained rapidly within minutes of the accident, and the hyperpathia resolved within a week. MRI showed contusion of the spinal cord at T10 level but no associated osseoligamentous injury. Six months later, parasthesia and subjective weakness remained in the left lower limb. To our knowledge, this is the first description of a lower thoracic spinal cord injury without radiographic abnormality following an isolated low-energy injury in a skeletally mature patient.

  18. 急性脊髓损伤患者并发低钠血症的危险因素分析及护理%Risk Factors of Acute Spinal Cord Injury Patients Complicated with Hyponatremia and Nursing Strategy

    Institute of Scientific and Technical Information of China (English)

    鲍娟; 章泾萍; 罗琨; 何爱兄; 徐智华

    2013-01-01

      目的探讨急性脊髓损伤患者并发低钠血症的危险因素,以提供针对性的护理干预措施,提高护理质量,改善患者预后.方法回顾性分析121例确诊为急性脊髓损伤患者,根据有无并发低钠血症将患者分为两组,分析年龄、性别、损伤平面、完全截瘫、损伤严重程度、精神状态、甘露醇使用、激素使用、高热、腹泻、合并感染、合并颅脑损伤及血糖、血钾值等指标对其发生的影响,采用单因素分析和Logistic多元回归分析.结果脊髓损伤患者低钠血症发生率为43.8%,多因素Logistic回归模型分析显示:高热、合并颅脑损伤是低钠血症发生的独立危险因素(P<0.05).结论高热和合并颅脑损伤是急性脊髓损伤患者并发低钠血症的独立危险因素.应针对危险因素早期加强护理评估和护理干预,降低急性脊髓损伤后低钠血症的发生率.%Objective To investigate the risk factors and nursing measures of acute spinal cord injury with hyponatremia. Methods One hundred and twenty-one patients diagnosed as acute spinal cord injury were analyzed retrospectively. And the patients were divided into two groups according to whether complicated with hyponatremia. Multiple possible influence factors including age, gender, injury level, complete paraplegia or not, Frankel classification, mental status, use of mannitol, use of glucocorticoid, hyperthermia or not, diarrhea or not, whether combined with infection, whether combined with brain injury, blood glucose and serum potassium were studied by univariate analysis and multivariate Logistic regression analysis. Results Hyponatremia occurred in 43.8%of the patients with spinal cord injury. Multivariate Logistic regression analysis showed that hyperthermia (OR=1.927, P=0.048) and combined with brain injury were independent risk factors of hyponatremia (OR=3.132, P=0.042). Conclusion Hyperthermia and combined with brain injury are

  19. Influence of Spinal Cord Integrity on Gait Control in Human Spinal Cord Injury.

    Science.gov (United States)

    Awai, Lea; Bolliger, Marc; Ferguson, Adam R; Courtine, Grégoire; Curt, Armin

    2016-07-01

    Background Clinical trials in spinal cord injury (SCI) primarily rely on simplified outcome metrics (ie, speed, distance) to obtain a global surrogate for the complex alterations of gait control. However, these assessments lack sufficient sensitivity to identify specific patterns of underlying impairment and to target more specific treatment interventions. Objective To disentangle the differential control of gait patterns following SCI beyond measures of time and distance. Methods The gait of 22 individuals with motor-incomplete SCI and 21 healthy controls was assessed using a high-resolution 3-dimensional motion tracking system and complemented by clinical and electrophysiological evaluations applying unbiased multivariate analysis. Results Motor-incomplete SCI patients showed varying degrees of spinal cord integrity (spinal conductivity) with severe limitations in walking speed and altered gait patterns. Principal component (PC) analysis applied on all the collected data uncovered robust coherence between parameters related to walking speed, distortion of intralimb coordination, and spinal cord integrity, explaining 45% of outcome variance (PC 1). Distinct from the first PC, the modulation of gait-cycle variables (step length, gait-cycle phases, cadence; PC 2) remained normal with respect to regained walking speed, whereas hip and knee ranges of motion were distinctly altered with respect to walking speed (PC 3). Conclusions In motor-incomplete SCI, distinct clusters of discretely controlled gait parameters can be discerned that refine the evaluation of gait impairment beyond outcomes of walking speed and distance. These findings are specifically different from that in other neurological disorders (stroke, Parkinson) and are more discrete at targeting and disentangling the complex effects of interventions to improve walking outcome following motor-incomplete SCI.

  20. Effect of robotic gait training on cardiorespiratory system in incomplete spinal cord injury

    NARCIS (Netherlands)

    Hoekstra, Femke; van Nunen, Michiel P. M.; Gerrits, Karin H. L.; Stolwijk-Swuste, Janneke M.; Crins, Martine H. P.; Janssen, Thomas W. J.

    2013-01-01

    The objectives in this study were to investigate the effect of robot-assisted gait training on cardiorespiratory fitness in subjects with motor incomplete spinal cord injury and document the exercise intensity of robotic walking in comparison with the recommended guidelines. Ten patients followed a

  1. Comparison of Electric Stimulation Methods for Reduction of Triceps Surae Spasticity in Spinal Cord Injury

    NARCIS (Netherlands)

    Salm, van der Arjan; Veltink, Peter H.; IJzerman, Maarten J.; Groothuis-Oudshoorn, Karin C.; Nene, Anand V.; Hermens, Hermie J.

    2006-01-01

    Objectives: To compare the effect of 3 methods of electric stimulation to reduce spasticity of the triceps surae in patients with complete spinal cord injury (SCI) and to investigate the carryover effect. - Design: Placebo-controlled study with repeated measurements after the interventions. - Settin

  2. Spinal cord injury caused by direct damage by local anaesthetic infiltration needle

    NARCIS (Netherlands)

    Absalom, AR; Martinelli, G; Scott, NB

    2001-01-01

    We describe a case of spinal cord injury caused by direct trauma from a local anaesthetic infiltration needle. During local anaesthetic infiltration before placement of an epidural catheter, the patient suddenly rolled over onto her back, causing the infiltrating needle to advance all the way to its

  3. How does the human brain deal with a spinal cord injury?

    NARCIS (Netherlands)

    Bruehlmeier, M; Dietz, [No Value; Leenders, KL; Roelcke, U; Missimer, J; Curt, A

    1998-01-01

    The primary sensorimotor cortex of the adult brain is capable of significant reorganization of topographic maps after deafferentation and de-efferentation. Here we show that patients with spinal cord injury exhibit extensive changes in the activation of cortical and subcortical brain areas during

  4. Effect of robotic gait training on cardiorespiratory system in incomplete spinal cord injury

    NARCIS (Netherlands)

    Hoekstra, Femke; van Nunen, Michiel P. M.; Gerrits, Karin H. L.; Stolwijk-Swuste, Janneke M.; Crins, Martine H. P.; Janssen, Thomas W. J.

    2013-01-01

    The objectives in this study were to investigate the effect of robot-assisted gait training on cardiorespiratory fitness in subjects with motor incomplete spinal cord injury and document the exercise intensity of robotic walking in comparison with the recommended guidelines. Ten patients followed a

  5. Possible Role of Large Fluid Intake in Delaying Formation of Encrustations and, thereby, Prolonging Working Life of Memokath Stent for Nearly 14 Years in a Spinal Cord Injury Patient

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2007-01-01

    Full Text Available The Memokath stent has been used in spinal cord injury patients as a reversible alternative to external urethral sphincterotomy, but the stent has a finite lifetime of <2 years before failure in the majority of patients. We report an unusual case of a spinal cord injury patient in whom memokath stent was functioning for almost 14 years. The long life span of the Memokath in this patient was probably due to this person's habit of drinking around 5 l of fluids a day. Large fluid intake resulted in high urine output and, consequently, deceased the risk of urine infections and delayed formation of encrustations around the stent. Although this case represents an unusual length of time for a Memokath stent to have been in place and functioning, caution should be exercised against the long-term use of Memokath stents. Memokath stents do not get absorbed into the mucosa unlike urolume stents and, therefore, are prone to stone formation. Further, Memokath stents have not yet been approved in the U.S. either for bladder outlet obstruction or detrusor-sphincter dyssynergia. This case is also a reminder to health professionals that if a tetraplegic patient, in whom a Memokath stent has been deployed for treatment of detrusor-sphincter dyssynergia, presents with autonomic dysreflexia, encrustations blocking the lumen of the stent or calculus formation around the stent should be considered as possible reasons for autonomic dysreflexia.

  6. Employment among Spinal Cord Injured Patients Living in Turkey: A Cross-Sectional Study

    Science.gov (United States)

    Gunduz, Berrin; Erhan, Belgin; Bardak, Ayse Nur

    2010-01-01

    The aim of this study was to determine the rate of employment and to establish the factors affecting vocational status in spinal cord injured patients living in Turkey. One hundred and fifty-two traumatic spinal cord injured patients older than 18 years with injury duration of at least 1 year and living in the community were included in the study;…

  7. Dysregulation of Kv3.4 Channels in Dorsal Root Ganglia Following Spinal Cord Injury

    OpenAIRE

    Ritter, David M.; Zemel, Benjamin M.; Hala, Tamara J.; O'Leary, Michael E; Lepore, Angelo C.; Covarrubias, Manuel

    2015-01-01

    Spinal cord injury (SCI) patients develop chronic pain involving poorly understood central and peripheral mechanisms. Because dysregulation of the voltage-gated Kv3.4 channel has been implicated in the hyperexcitable state of dorsal root ganglion (DRG) neurons following direct injury of sensory nerves, we asked whether such a dysregulation also plays a role in SCI. Kv3.4 channels are expressed in DRG neurons, where they help regulate action potential (AP) repolarization in a manner that depen...

  8. Effects of visual illusion and transcutaneous electrical nerve stimulation on neuropathic pain in patients with spinal cord injury: A randomised controlled cross-over trial.

    Science.gov (United States)

    Özkul, Çağla; Kılınç, Muhammed; Yıldırım, Sibel Aksu; Topçuoğlu, Elif Yalçın; Akyüz, Müfit

    2015-01-01

    Chronic pain is a common consequence of spinal cord injury (SCI). No therapeutic drugs or drug groups are proven to be superior for neuropathic pain and treatments only aim to convert pain from dull to tolerable levels and not to remove it. This study was planned to compare the effect of visual illusion (VI) and transcutaneous electrical nerve stimulation (TENS) on pain intensity, pain quality and functional capacity in SCI patients with neuropathic pain. Twenty-four patients were included and randomly categorized into two groups. In the first group (n= 12), visual illusion was applied for first two weeks, 1 week wash out period and then TENS was applied for 2 weeks. In second group (n= 12), TENS was applied firstly, 1 week wash out and then %visual illusion VI were applied. Pain severity, pain quality, and functional capacity were assessed with the visual analog scale (VAS), the neuropathic pain scale (NPS), and the brief pain inventory (BPI), respectively. A pre-post-treatment and cross over design was used. Wilcoxon signed-rank tests were used for within group analyses. Mann-Whitney U tests were used for analyses that compared different groups. It was observed that pain intensity decrease immediately after both applications (VI: p= 0.07, TENS: p= 0.08). After TENS application for 2 weeks, it was observed that significant decrease in most (p= 0.04) and less (p= 0.02) pain intensity; while there was no significant decrease in pain intensity after 2 weeks for VI (p> 0.05). When findings of NPS were analyzed, hot (p= 0.047), sharp (p= 0.02), unpleasant (p= 0.03) and deep items (p= 0.047) decreased after VI application. When the results of BPI were detected, they were observed that the negative effect of pain on moving ability (p= 0.04) after visual illusion application and the negative effect of pain on mood (p= 0.03), relationships with others (p= 0.04) and sleep (p= 0.04) after TENS application decreased significantly. TENS and VI therapies can be successfully

  9. MINIMALLY-INVASIVE FIXATION OF SPINAL CORD INJURY PATIENT USING MIDLINE INCISION- AN ANALYSIS OF 11 CASES

    Directory of Open Access Journals (Sweden)

    Anand Shankar

    2017-02-01

    Full Text Available BACKGROUND Instrumenting the fractured spinal column has seen many changes in last 5 decades. Starting from Luque’s rod (Dr. Eduardo Luque, Hartshill’s rectangle, the Harrington rod (Dr. Paul Harrington, Variable Spinal Plating (VSP, pedicle screw and rod fixation being the latest. The emphasis is on minimally invasive and least possible trauma to paraspinal muscles. Percutaneous pedicle screw fixation is at present a gold standard of minimally-invasive procedure. MATERIALS AND METHODS 11 patients were operated between August 2013 till March 2016 with this method and the outcome was evaluated. RESULTS The neurological recovery is not the goal of spinal column fixation in SCI patients in most of the cases. The only goal is stabilisation of spinal column, pain relief, rehabilitation, prevention of bedsore, RTI by achieving vertical chest, UTI by preventing stasis of urine in bladder, etc. CONCLUSION The presenting operative procedure for achieving this goal of stabilisation is very well achieved in 10 out of 11 cases with minimal soft tissue trauma. The improvement in alignment and restoration of anatomy of spinal column, restoration of spinal canal diameter as judged radiologically is achieved in 9 of out of 11 cases.

  10. Trigemino-cervical reflex in spinal cord injury.

    Science.gov (United States)

    Gündüz, Ayşegül; Uzun, Nurten; Örnek, Nurettin İrem; Ünalan, Halil; Karamehmetoğlu, Şafak Sahir; Kızıltan, Meral E

    2014-09-19

    Abnormal enhancement of polysynaptic brainstem reflexes has been previously reported in patients with spinal cord injury (SCI). We aimed to investigate trigemino-cervical reflex (TCR) in SCI since it may reflect alterations in the connections of trigeminal proprioceptive system and cervical motoneurons. Consecutive 14 patients with SCI and 16 healthy subjects were included in this study. All patients were in the chronic phase. TCR was recorded over sternocleidomastoid (SCM) and splenius capitis (SC) muscles by stimulation of infraorbital nerve. We measured onset latency, amplitudes and durations of responses and compared between groups. We obtained stable responses over both muscles after one sided stimulation in healthy volunteers whereas probability of TCR was decreased in patients over both SCM (78.6% vs. 100%, p=0.050) and SC (71.4% vs. 100%, p=0.022). The absence of TCR was related to use of oral baclofen (≥50mg/day). However, when present, responses of SCI group had higher amplitudes and were more persistent. We demonstrated that TCR probability was similar to healthy subjects in SCI patients who used no or low dose oral baclofen. But it had higher amplitudes and longer durations. It was not obtained in only two patients who used oral baclofen more than 50mg/day.

  11. The Potential of Curcumin in Treatment of Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Raghavendra Sanivarapu

    2016-01-01

    Full Text Available Current treatment for spinal cord injury (SCI is supportive at best; despite great efforts, the lack of better treatment solutions looms large on neurological science and medicine. Curcumin, the active ingredient in turmeric, a spice known for its medicinal and anti-inflammatory properties, has been validated to harbor immense effects for a multitude of inflammatory-based diseases. However, to date there has not been a review on curcumin’s effects on SCI. Herein, we systematically review all known data on this topic and juxtapose results of curcumin with standard therapies such as corticosteroids. Because all studies that compare the two show superior results for curcumin over corticosteroids, it could be true that curcumin better acts at the inflammatory source of SCI-mediated neurological injury, although this question remains unanswered in patients. Because curcumin has shown improvements from current standards of care in other diseases with few true treatment options (e.g., osteoarthritis, there is immense potential for this compound in treating SCI. We critically and systematically summarize available data, discuss clinical implications, and propose further testing of this well-tolerated compound in both the preclinical and the clinical realms. Analyzing preclinical data from a clinical perspective, we hope to create awareness of the incredible potential that curcumin shows for SCI in a patient population that direly needs improvements on current therapy.

  12. Development of locomotion after spinal cord injury in small animals – Literature review

    Directory of Open Access Journals (Sweden)

    Andréia Coutinho Facin

    2016-05-01

    Full Text Available Spinal cord injuries are common in cats and dogs and result in severe neurological deficit, which can lead to permanent loss of sensory and motor capacity. In patients with fair to poor prognoses, complementary treatments have been used to develop an involuntary and uncoordinated ambulation that resembles normal gait, commonly known as spinal locomotion or reflexive stepping. Under experimental conditions, the recovery of a rhythmic gait has been reported following complete spinal cord transection. In veterinary medicine, the development of reflex stepping is of extreme importance to the quality of life and independence of the patients, as well as the satisfaction and tranquility of the owners. The present study is a literature review about the development of locomotion after spinal cord injury in small animals.

  13. Acute central cord syndrome: injury mechanisms and stress features.

    Science.gov (United States)

    Li, Xin-Feng; Dai, Li-Yang

    2010-09-01

    Numerical techniques were used to study the mechanisms of acute central cord syndrome. To analyze the features of stress distribution in the cervical cord under different injury conditions using finite element model of the cervical cord and to improve the understanding of the possible pathogenesis of acute central cord syndrome. Acute central cord spinal injury was initially attributed to hemorrhagic damage to the central portion of the spinal cord, but recent histopathologic studies showed that it was predominantly a white matter injury. The precise anatomic location of neuronal injury and the etiology of the clinical manifestation were poorly understood. Cervical cord injury was simulated using a finite element model of the cervical enlargement described previously, with the model loaded under 3 traumatic postures: neutral, flexion, and extension. Five traumatic conditions were simulated and analyzed: hyperextension with the pinch force directed to the anterior (A) or posterior (B); flexion injuries (C), vertical compression with the pinch force directed to the anterior (D) or posterior (E). After simulation, several representative cross-sections of each traumatic pattern were selected. In each cross-section, the average von Mises stress of 9 regions, such as anterior funiculus, lateral part of the lateral funiculus, medial part of the lateral funiculus, lateral part of the posterior funiculus, medial part of the posterior funiculus, anterior horn, the bottom of anterior horn, the cervix cornu posterioris, the caput cornu posterioris, and the apex cornu posterioris was recorded. High localized stress occurred at the portion under compression injury and the level above it. High localized stress tended to occur at the lateral part of the anterior horn motor neurons innervating the hand muscles in traumatic conditions A and D. Under conditions A, D, and E, the average localized stress at the anterior and posterior horn of the gray matter was higher than that at the

  14. Traumatic spinal cord injury: current concepts and treatment update

    Directory of Open Access Journals (Sweden)

    Carolina Rouanet

    Full Text Available ABSTRACT Spinal cord injury (SCI affects 1.3 million North Americans, with more than half occurring after trauma. In Brazil, few studies have evaluated the epidemiology of SCI with an estimated incidence of 16 to 26 per million per year. The final extent of the spinal cord damage results from primary and secondary mechanisms that start at the moment of the injury and go on for days, and even weeks, after the event. There is convincing evidence that hypotension contributes to secondary injury after acute SCI. Surgical decompression aims at relieving mechanical pressure on the microvascular circulation, therefore reducing hypoxia and ischemia. The role of methylprednisolone as a therapeutic option is still a matter of debate, however most guidelines do not recommend its regular use. Neuroprotective therapies aiming to reduce further injury have been studied and many others are underway. Neuroregenerative therapies are being extensively investigated, with cell based therapy being very promising.

  15. Detection of gene expression pattern in the early stage after spinal cord injury by gene chip

    Institute of Scientific and Technical Information of China (English)

    刘成龙; 靳安民; 童斌辉

    2003-01-01

    Objective: To study the changes of the gene expression pattern of spinal cord tissues in the early stage after injury by DNA microarray (gene chip). Methods: The contusion model of rat spinal cord was established according to Allen's falling strike method and the gene expression patterns of normal and injured spinal cord tissues were studied by gene chip. Results: The expression of 45 genes was significantly changed in the early stage after spinal cord injury, in which 22 genes up-regulated and 23 genes down-regulated. Conclusions: The expression of some genes changes significantly in the early stage after spinal cord injury, which indicates the complexity of secondary spinal cord injury.

  16. Investigation of the care burden and self efficacy of caregivers of patients with spinal cord injury%脊髓损伤患者照顾者照顾负担与自我效能的调查分析

    Institute of Scientific and Technical Information of China (English)

    马海萍; 卢惠娟; 姚剑英; 杨晓莉

    2013-01-01

    Objective To investigate the level of care burden and self efficacy of caregivers of patients with spinal cord injury,and analyze their correlation.Methods By convenience sampling method,150 cases of spinal cord injury patients and their caregivers were investigated with Zarit Caregiver Burden Scale and general self-efficacy scale.Results The score of care burden of caregivers with spinal cord injury was (52.91 ± 11.56) points,self-efficacy score of caregivers was (19.63 ± 4.85) points.The score of care burden of caregivers and self-efficacy was highly negatively correlated.Conclusions We should pay more attention to improve the self-efficacy of caregivers of patients with spinal cord injury (SCI),in order to mitigate the care burden,improve care ability and health level of the patients' families.%目的 调查脊髓损伤患者照顾者的照顾负担及自我效能水平并分析其相关关系.方法 通过便利抽样法,采用Zarit护理负担量表、一般自我效能量表,对150例脊髓损伤患者及其照顾者进行调查.结果 脊髓损伤患者照顾者的照顾负担总分为(52.91±11.56)分,照顾者自我效能得分为(19.63±4.85)分,照顾者的照顾负担与自我效能水平显著负相关.结论 应重视提高脊髓损伤患者照顾者的自我效能感,以减轻其照顾负担,提高照顾能力及患者所在家庭的健康水平.

  17. Experimental study on spinal cord injury treated by embryonic spinal cord transplantation and greater omental transposition

    Institute of Scientific and Technical Information of China (English)

    Hao Dingjun(郝定均); Zheng Yonghong(郑永宏); Yuan Fuyong(袁福镛); He Liming; Wang Rong; Yuan Yong

    2004-01-01

    Objective: To observe the clinical efficacy of the embryonic spinal cellular transplantation and greater omental transposition for treatment of the spinal cord injury in 24 mongrel dogs. Methods: 24 adult mongrel dogs, weighing 10 ~ 13kg,bryonic spinal cellular transplantation and greater omental transposition group (group D). Each group consisted of 6 dogs. SEP(somatosensory evoked potential) and MEP (motor evoked potential) of the spinal cord were examed prior to the spinal cord injury and 2 months after the treatment to observe the changes of the animals' behavior. All dogs were killed 2 months after surgery and the spinal cord sections were obtained from T12 to L1 level for pathological analysis and observation under the electron microscope.Results: There was an obvious difference in the spinal somatosensory evoked potential and the motor evoked potential between the group D and the other three groups (group A, B, and C). Recovery of the behavior was noted. The spinal cells had survived for two months following the transplantation. Conclusion: Transplantation of the embryonic spinal cell and greater omentum for treatment of the spinal cord injury in dogs can gain a better outcome than the other groups in behavior and spinal somatosensory and motor evoked potential, but the further study is still essential to confirm its clinical efficacy.

  18. Gastrocnemius muscle contracture after spinal cord injury: a longitudinal study.

    Science.gov (United States)

    Diong, Joanna; Harvey, Lisa A; Kwah, Li Khim; Clarke, Jillian L; Bilston, Lynne E; Gandevia, Simon C; Herbert, Robert D

    2013-07-01

    The aim of this study was to examine changes in passive length and stiffness of the gastrocnemius muscle-tendon unit in people after spinal cord injury. In a prospective longitudinal study, eight wheelchair-dependent participants with severe paralysis were assessed 3 and 12 mos after spinal cord injury. Passive torque-angle data were obtained as the ankle was slowly rotated through range at six knee angles. Differences in passive ankle torque-angle data recorded at different knee angles were used to derive passive length-tension curves of the gastrocnemius muscle-tendon unit. Ultrasound imaging was used to determine fascicle and tendon contributions to the muscle-tendon unit length-tension curves. The participants had ankle contractures (mean [SD] maximum passive ankle dorsiflexion angle, 88 [9] degrees) 3 mos after spinal cord injury. Ankle range did not worsen significantly during the subsequent 9 mos (mean change, -5 degrees; 95% confidence interval, -16 to 6 degrees). There were no changes in the mean slack length or the stiffness of the gastrocnemius muscle-tendon unit or in the slack lengths of the fascicles or the tendon between 3 and 12 mos after spinal cord injury. There were no consistent patterns of the change in slack length or stiffness with the changes in ankle range in the data from the individual participants. This study, the first longitudinal study of muscle length and stiffness after spinal cord injury, showed that the length and the stiffness of the gastrocnemius did not change substantially between 3 and 12 mos after injury.

  19. [Nursing care in males with spinal cord injury and sexual dysfunction].

    Science.gov (United States)

    Cobo-Cuenca, Ana Isabel; Martín-Espinosa, Noelia M; Píriz Campos, Rosa M

    2013-01-01

    The impact of spinal cord injury and its sequels requires important efforts of adaptation. In several studies, people with spinal cord injury claim to have covered most of their needs at physical, emotional and social level, but they are not yet fully satisfied with their sexual life. Sexual function is usually impaired in men with spinal cord injuries, and is sometimes related to problems of erection, ejaculation and/or orgasm. This issue is not a priority in the first phase, but it appears over the subsequent periods when patients often ask for a solution to this problem. A case-study is presented of a 25 year old male with chronic complete spinal cord injury (ASIA A), L4-L5 level, who reported sexual dysfunction and attended an annual review in the National Hospital for Paraplegics. After performing a nursing assessment using the functional health patterns of Gordon, the team proposed a nursing care plan according to the taxonomy of NANDA (North American Nursing Association), NOC (Nursing Outcome Classification) and NIC (Nursing Intervention Classification). Nurses are the healthcare professionals who have more direct and continuous contact with these patients. Specific programs need to be designed to provide them with the sexual education, which should contain adequate emotional and sexual information. We believe that an appropriate and systematic assessment of patient's sexuality, as well as the application of the (NANDA, NOC, NIC) nurse methodology, may be very helpful in improving the outcomes of these specific interventions.

  20. Descrição da aptidão inicial para natação em lesionados medulares Description of initial swimming ability in patients with spinal cord injury

    Directory of Open Access Journals (Sweden)

    Ana Cláudia Raposo Melo

    2009-12-01

    Full Text Available Este estudo tem por objetivos verificar o retorno à natação após a lesão medular e descrever a aptidão inicial de lesionados medulares para o nado como parte das atividades do programa de reabilitação no Hospitalar Sarah-Centro. MÉTODOS: Foram avaliados 170 pacientes com diagnóstico de paraplegia e tetraplegia, em três etapas - levantamento de dados em prontuário, entrevista oral e avaliação do padrão do nado. Os resultados apontaram que grande parte dos pacientes não entrou na piscina ou realizou nado após a lesão medular. A avaliação da adaptação ao meio líquido após a lesão medular demonstrou que grande parte dos pacientes realizou a imersão e flutuação de forma independente, porém, apresentando dificuldade em mudar de decúbito dentro da água. Apenas uma pequena porcentagem retomou a natação após a lesão medular; foi também verificada redução no total dos sujeitos que nadavam regularmente antes. A avaliação apontou que os nados crawl e de costas foram realizados por metade dos avaliados; apenas uma pequena parte realizou nado de peito. CONCLUSÃO: Após a avaliação dos relatos dos pacientes, verificou-se redução na prática da natação, seja como atividade esportiva, física ou de lazer após a lesão medular, apesar de a aptidão para o nado não ter sofrido grandes alterações.Pysical activity, particularly swimming, that brings a lot of benefits to subjects with spinal cord injury, can be started during rehabilitation. The aims of this study were to describe the initial ability to swim of patients with spinal cord injury during the rehabilitation program at the Sarah Hospital - Center. METHODS: 170 patients were evaluated in three steps - medical records data collection, oral interview and swimming evaluation. The results showed that a large proportion of patients did not enter the swimming pool or swam after spinal cord injury. Only a small part returned to swimming after the spinal cord

  1. Stem cell-based therapies for spinal cord injury.

    Science.gov (United States)

    Nandoe Tewarie, Rishi S; Hurtado, Andres; Bartels, Ronald H; Grotenhuis, Andre; Oudega, Martin

    2009-01-01

    Spinal cord injury (SCI) results in loss of nervous tissue and consequently loss of motor and sensory function. There is no treatment available that restores the injury-induced loss of function to a degree that an independent life can be guaranteed. Transplantation of stem cells or progenitors may support spinal cord repair. Stem cells are characterized by self-renewal and their ability to become any cell in an organism. Promising results have been obtained in experimental models of SCI. Stem cells can be directed to differentiate into neurons or glia in vitro, which can be used for replacement of neural cells lost after SCI. Neuroprotective and axon regeneration-promoting effects have also been credited to transplanted stem cells. There are still issues related to stem cell transplantation that need to be resolved, including ethical concerns. This paper reviews the current status of stem cell application for spinal cord repair.

  2. Diagnosis and management of traumatic cervical central spinal cord injury: A review

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2015-01-01

    Full Text Available Background: The classical clinical presentation, neuroradiographic features, and conservative vs. surgical management of traumatic cervical central spinal cord (CSS injury remain controversial. Methods: CSS injuries, occurring in approximately 9.2% of all cord injuries, are usually attributed to significant hyperextension trauma combined with congenital/acquired cervical stenosis/spondylosis. Patients typically present with greater motor deficits in the upper vs. lower extremities accompanied by patchy sensory loss. T2-weighted magnetic resonance (MR scans usually show hyperintense T2 intramedullary signals reflecting acute edema along with ligamentous injury, while noncontrast computed tomography (CT studies typically show no attendant bony pathology (e.g. no fracture, dislocation. Results: CSS constitute only a small percentage of all traumatic spinal cord injuries. Aarabi et al. found CSS patients averaged 58.3 years of age, 83% were male and 52.4% involved accidents/falls in patients with narrowed spinal canals (average 5.6 mm; their average American Spinal Injury Association (ASIA motor score was 63.8, and most pathology was at the C3-C4 and C4-C5 levels (71%. Surgery was performed within 24 h (9 patients, 24-48 h (10 patients, or after 48 h (23 patients. In the Brodell et al. study of 16,134 patients with CSS, 39.7% had surgery. In the Gu et al. series, those with CSS and stenosis/ossification of the posterior longitudinal ligament (OPLL exhibited better outcomes following laminoplasty. Conclusions: Recognizing the unique features of CSS is critical, as the clinical, neuroradiological, and management strategies (e.g. conservative vs. surgical management: early vs. late differ from those utilized for other spinal cord trauma. Increased T2-weighted MR images best document CSS, while CT studies confirm the absence of fracture/dislocation.

  3. Peripheral nervous system involvement in chronic spinal cord injury

    DEFF Research Database (Denmark)

    Tankisi, Hatice; Pugdahl, Kirsten; Rasmussen, Mikkel Mylius

    2015-01-01

    Introduction: Upper motor neuron disorders are believed to leave the peripheral nervous system (PNS) intact. In this study we examined whether there is evidence of PNS involvement in spinal cord injury (SCI). Methods: Twelve subjects with chronic low cervical or thoracic SCI were included...

  4. Human spinal cord injury : motor unit properties and behaviour

    NARCIS (Netherlands)

    Thomas, C. K.; Bakels, R.; Klein, C. S.; Zijdewind, I.

    2014-01-01

    Spinal cord injury (SCI) results in widespread variation in muscle function. Review of motor unit data shows that changes in the amount and balance of excitatory and inhibitory inputs after SCI alter management of motoneurons. Not only are units recruited up to higher than usual relative forces when

  5. Human spinal cord injury : motor unit properties and behaviour

    NARCIS (Netherlands)

    Thomas, C. K.; Bakels, R.; Klein, C. S.; Zijdewind, I.

    Spinal cord injury (SCI) results in widespread variation in muscle function. Review of motor unit data shows that changes in the amount and balance of excitatory and inhibitory inputs after SCI alter management of motoneurons. Not only are units recruited up to higher than usual relative forces when

  6. Postpartum spinal cord injury in a woman with HELLP syndrome.

    NARCIS (Netherlands)

    Groothuis, J.T.; Kuppevelt, DH van

    2008-01-01

    OBJECTIVE: To report a rare cause of spinal cord injury. STUDY DESIGN: Case report. CASE REPORT: A 36-year-old woman presented with acute onset of paresis of the upper and lower extremity (level C5, ASIA B) the day after delivering a healthy daughter (39 weeks' gestation). Prior to giving birth, she

  7. Advances in the management of infertility in men with spinal cord injury

    Directory of Open Access Journals (Sweden)

    Emad Ibrahim

    2016-01-01

    Full Text Available Couples with a spinal cord injured male partner require assisted ejaculation techniques to collect semen that can then be further used in various assisted reproductive technology methods to achieve a pregnancy. The majority of men sustaining a spinal cord injury regardless of the cause or the level of injury cannot ejaculate during sexual intercourse. Only a small minority can ejaculate by masturbation. Penile vibratory stimulation and electroejaculation are the two most common methods used to retrieve sperm. Other techniques such as prostatic massage and the adjunct application of other medications can be used, but the results are inconsistent. Surgical sperm retrieval should be considered as a last resort if all other methods fail. Special attention must be paid to patients with T6 and rostral levels of injury due to the risk of autonomic dysreflexia resulting from stimulation below the level of injury. Bladder preparation should be performed before stimulation if retrograde ejaculation is anticipated. Erectile dysfunction is ubiquitous in the spinal cord injured population but is usually easily managed and does not pose a barrier to semen retrieval in these men. Semen analysis parameters of men with spinal cord injury are unique for this population regardless of the method of retrieval, generally presenting as normal sperm concentration but abnormally low sperm motility and viability. When sperm retrieval is desired in this population, emphasis should be placed on initially trying the simple methods of penile vibratory stimulation or electroejaculation before resorting to more advanced and invasive surgical procedures.

  8. Interleukin-33 treatment reduces secondary injury and improves functional recovery after contusion spinal cord injury.

    Science.gov (United States)

    Pomeshchik, Yuriy; Kidin, Iurii; Korhonen, Paula; Savchenko, Ekaterina; Jaronen, Merja; Lehtonen, Sarka; Wojciechowski, Sara; Kanninen, Katja; Koistinaho, Jari; Malm, Tarja

    2015-02-01

    Interleukin-33 (IL-33) is a member of the interleukin-1 cytokine family and highly expressed in the naïve mouse brain and spinal cord. Despite the fact that IL-33 is known to be inducible by various inflammatory stimuli, its cellular localization in the central nervous system and role in pathological conditions is controversial. Administration of recombinant IL-33 has been shown to attenuate experimental autoimmune encephalomyelitis progression in one study, yet contradictory reports also exist. Here we investigated for the first time the pattern of IL-33 expression in the contused mouse spinal cord and demonstrated that after spinal cord injury (SCI) IL-33 was up-regulated and exhibited a nuclear localization predominantly in astrocytes. Importantly, we found that treatment with recombinant IL-33 alleviated secondary damage by significantly decreasing tissue loss, demyelination and astrogliosis in the contused mouse spinal cord, resulting in dramatically improved functional recovery. We identified both central and peripheral mechanisms of IL-33 action. In spinal cord, IL-33 treatment reduced the expression of pro-inflammatory tumor necrosis factor-alpha and promoted the activation of anti-inflammatory arginase-1 positive M2 microglia/macrophages, which chronically persisted in the injured spinal cord for up to at least 42 days after the treatment. In addition, IL-33 treatment showed a tendency towards reduced T-cell infiltration into the spinal cord. In the periphery, IL-33 treatment induced a shift towards the Th2 type cytokine profile and reduced the percentage and absolute number of cytotoxic, tumor necrosis factor-alpha expressing CD4+ cells in the spleen. Additionally, IL-33 treatment increased expression of T-regulatory cell marker FoxP3 and reduced expression of M1 marker iNOS in the spleen. Taken together, these results provide the first evidence that IL-33 administration is beneficial after CNS trauma. Treatment with IL33 may offer a novel therapeutic

  9. Spinal Cord Injury Caused by Stab Wounds: Incidence, Natural History, and Relevance for Future Research.

    Science.gov (United States)

    McCaughey, Euan J; Purcell, Mariel; Barnett, Susan C; Allan, David B

    2016-08-01

    Spinal cord injury caused by stab wounds (SCISW) results from a partial or complete transection of the cord, and presents opportunities for interventional research. It is recognized that there is low incidence, but little is known about the natural history or the patient's suitability for long-term clinical outcome studies. This study aims to provide population-based evidence of the demographics of SCISW, and highlight the issues regarding the potential for future research. The database of the Queen Elizabeth National Spinal Injuries Unit (QENSIU), the sole center for treating SCI in Scotland, was reviewed between 1994 and 2013 to ascertain the incidence, demographics, functional recovery, and mortality rates for new SCISW. During this 20 year period, 35 patients with SCISW were admitted (97.1% male, mean age 30.0 years); 31.4% had a cervical injury, 60.0% had a thoracic injury, and 8.6% had a lumbar injury. All had a neurological examination, with 42.9% diagnosed as motor complete on admission and 77.1% discharged as motor incomplete. A total of 70.4% of patients with an American Spinal Injury Association Impairment Scale (AIS) level of A to C on admission had an improved AIS level on discharge. Nine (25.7%) patients have died since discharge, with mean life expectancy for these patients being 9.1 years after injury (20-65 years of age). Patients had higher levels of comorbidities, substance abuse, secondary events, and poor compliance compared with the general SCI population, which may have contributed to the high mortality rate observed post-discharge. The low incidence, heterogeneous nature, spontaneous recovery rate, and problematic follow-up makes those with penetrating stab injuries of the spinal cord a challenging patient group for SCI research.

  10. Animal assisted therapy and the individual with spinal cord injury.

    Science.gov (United States)

    Counsell, C M; Abram, J; Gilbert, M

    1997-06-01

    Spinal cord injury (SCI) is a devastating event that results in significant adjustments during the acute and rehabilitation phase. During this period, it is imperative to maintain the patient's self-esteem, reduce stress levels, encourage the expression of feelings, and provide sensory stimulation. Animal Assisted Therapy (AAT) involves the use of animals as a complement to more traditional forms of therapy. The program is based on the knowledge that animals have a positive influence on people who are ill in the healthcare setting. The Animals Heal Hearts Program (TM) has two components, pet visitation and pet therapy. Pet visitation consists of allowing a patient to have his/her own personal dog for a visit, provided there are no medical contraindications. Pet therapy is a structured program using a dog that has completed behavioral and health screening. Dogs are used in the hospital to reduce patients' stress, increase their self-esteem, and help them express feelings. The dogs provide sensory stimulation as patients view and handle the animals and learn about animals and pets. A carefully planned and evaluated program ensures that it is safe and effective.

  11. Spinal-cord injuries in Australian footballers, 1960-1985.

    Science.gov (United States)

    Taylor, T K; Coolican, M R

    1987-08-03

    A review of 107 footballers who suffered a spinal-cord injury between 1960 and 1985 has been undertaken. Since 1977, the number of such injuries in Rugby Union, Rugby League and Australian Rules has increased, from an average of about two injuries a year before 1977 to over eight injuries a year since then. Rugby Union is clearly the most dangerous game, particularly for schoolboys; all of the injuries in schoolboy games for this code have occurred since 1977. This study has shown that collision at scrum engagement, and not at scrum collapse, is the way in which the majority of scrum injuries are sustained. These injuries are largely preventable, and suggestions for rule changes are made. Half the injured players recovered to Frankel grades D or E. The financial entitlements of those injured were grossly inadequate; this warrants action. A national register for spinal-cord injuries from football should be established to monitor the effects of desirable rule changes in Rugby Union and Rugby League.

  12. Meeting the privacy requirements for the development of a multi-centre patient registry in Canada: the Rick Hansen Spinal Cord Injury Registry.

    Science.gov (United States)

    Noonan, Vanessa K; Thorogood, Nancy P; Joshi, Phalgun B; Fehlings, Michael G; Craven, B Catharine; Linassi, Gary; Fourney, Daryl R; Kwon, Brian K; Bailey, Christopher S; Tsai, Eve C; Drew, Brian M; Ahn, Henry; Tsui, Deborah; Dvorak, Marcel F

    2013-05-01

    Privacy legislation addresses concerns regarding the privacy of personal information; however, its interpretation by research ethics boards has resulted in significant challenges to the collection, management, use and disclosure of personal health information for multi-centre research studies. This paper describes the strategy used to develop the national Rick Hansen Spinal Cord Injury Registry (RHSCIR) in accordance with privacy statutes and benchmarked against best practices. An analysis of the regional and national privacy legislation was conducted to determine the requirements for each of the 31 local RHSCIR sites and the national RHSCIR office. A national privacy and security framework was created for RHSCIR that includes a governance structure, standard operating procedures, training processes, physical and technical security and privacy impact assessments. The framework meets a high-water mark in ensuring privacy and security of personal health information nationally and may assist in the development of other national or international research initiatives.

  13. Meeting the Privacy Requirements for the Development of a Multi-Centre Patient Registry in Canada: The Rick Hansen Spinal Cord Injury Registry

    Science.gov (United States)

    Noonan, Vanessa K.; Thorogood, Nancy P.; Joshi, Phalgun B.; Fehlings, Michael G.; Craven, B. Catharine; Linassi, Gary; Fourney, Daryl R.; Kwon, Brian K.; Bailey, Christopher S.; Tsai, Eve C.; Drew, Brian M.; Ahn, Henry; Tsui, Deborah; Dvorak, Marcel F.

    2013-01-01

    Privacy legislation addresses concerns regarding the privacy of personal information; however, its interpretation by research ethics boards has resulted in significant challenges to the collection, management, use and disclosure of personal health information for multi-centre research studies. This paper describes the strategy used to develop the national Rick Hansen Spinal Cord Injury Registry (RHSCIR) in accordance with privacy statutes and benchmarked against best practices. An analysis of the regional and national privacy legislation was conducted to determine the requirements for each of the 31 local RHSCIR sites and the national RHSCIR office. A national privacy and security framework was created for RHSCIR that includes a governance structure, standard operating procedures, training processes, physical and technical security and privacy impact assessments. The framework meets a high-water mark in ensuring privacy and security of personal health information nationally and may assist in the development of other national or international research initiatives. PMID:23968640

  14. Development of an Animal Model of Thoracolumbar Burst Fracture Induced Acute Spinal Cord Injury

    Science.gov (United States)

    2015-05-01

    AWARD NUMBER: W81XWH-14-2-0013 TITLE: DEVELOPMENT OF AN ANIMAL MODEL OF THORACOLUMBAR BURST FRACTURE- INDUCED ACUTE SPINAL CORD INJURY...2015 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER DEVELOPMENT OF AN ANIMAL MODEL OF THORACOLUMBAR BURST FRACTURE-INDUCED ACUTE SPINAL CORD INJURY 5b...controlled spinal cord impactor for use in large animal models of SCI in order to more reliably recreate the human injury. A custom designed spinal cord

  15. Research Progress of Urinary Tract Infections in Patients with Spinal Cord Injury (review)%脊髓损伤患者泌尿系感染研究进展

    Institute of Scientific and Technical Information of China (English)

    朱佳琪; 马跃文; 陈锐

    2016-01-01

    Urinary tract infections remain the most frequent infection in patients with either traumatic or nontraumatic spinal cord inju-ry. The urinary tract infections are closely related to impaired bladder storage, voiding dysfunction, and use of indwelling catheters after spi-nal cord injury. Repeated urinary tract infections can cause upper urinary tract deterioration, and related chronic or repeated exposure to the antibiotics used to treat urinary tract infections increases the risk of multidrug-resistant bacteria colonization. Therefore, it is important to de-termine appropriate urinary tract infections treatment in spinal cord injury patients who are admitted to rehabilitation hospitals. The limita-tions of the usual measures in prevention of urinary tract infections in this population have led the way to explore more innovative modali-ties and approaches. We reviewed the researches of urinary tract infections on spinal cord injury. It is presented to provide reference for clini-cal diagnosis and treatment.%脊髓损伤患者的泌尿系感染通常与泌尿系结石、排空障碍以及应用导尿管相关,是创伤性或非创伤性脊髓损伤患者最常见的感染原因。反复泌尿系感染会引起肾功能损伤,而为了控制感染长期反复应用抗生素可能导致多重耐药菌定植进一步恶化感染。因此,康复阶段脊髓损伤患者泌尿系感染的预防、治疗方案的确定显得尤为重要。为了改善这类患者的预后,近年来各国研究者提出了许多新的临床经验及实验室方案,本文综述对脊髓损伤后泌尿系感染诊疗相关研究,以期对临床医疗提供借鉴。

  16. Neuroprotective Effect of Ulinastatin on Spinal Cord Ischemia-Reperfusion Injury in Rabbits

    Directory of Open Access Journals (Sweden)

    Bingbing Liu

    2015-01-01

    Full Text Available Ulinastatin (UTI, a trypsin inhibitor, is isolated and purified from human urine and has been shown to exert protective effect on myocardial ischemia reperfusion injury in patients. The present study was aimed at investigating the effect of ulinastatin on neurologic functions after spinal cord ischemia reperfusion injury and the underlying mechanism. The spinal cord IR model was achieved by occluding the aorta just caudal to the left renal artery with a bulldog clamp. The drugs were administered immediately after the clamp was removed. The animals were terminated 48 hours after reperfusion. Neuronal function was evaluated with the Tarlov Scoring System. Spinal cord segments between L2 and L5 were harvested for pathological and biochemical analysis. Ulinastatin administration significantly improved postischemic neurologic function with concomitant reduction of apoptotic cell death. In addition, ulinastatin treatment increased SOD activity and decreased MDA content in the spinal cord tissue. Also, ulinastatin treatment suppressed the protein expressions of Bax and caspase-3 but enhanced Bcl-2 protein expression. These results suggest that ulinastatin significantly attenuates spinal cord ischemia-reperfusion injury and improves postischemic neuronal function and that this protection might be attributable to its antioxidant and antiapoptotic properties.

  17. Urinary calculi following traumatic spinal cord injury

    DEFF Research Database (Denmark)

    Hansen, Rikke Bølling; Biering-Sørensen, Fin; Kristensen, Jørgen Kvist

    2007-01-01

    calculi was higher in the SCI population compared to the normal population. Bladder calculi primarily occur early post-injury and renal calculi appear both early post-injury and years later. Therefore, it is important to follow individuals with SCI regularly by means of urological investigations from...

  18. Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury: Update and Preliminary Outcomes.

    Science.gov (United States)

    Fox, Ida K; Davidge, Kristen M; Novak, Christine B; Hoben, Gwendolyn; Kahn, Lorna C; Juknis, Neringa; Ruvinskaya, Rimma; Mackinnon, Susan E

    2015-10-01

    Cervical spinal cord injury can result in profound loss of upper extremity function. Recent interest in the use of nerve transfers to restore volitional control is an exciting development in the care of these complex patients. In this article, the authors review preliminary results of nerve transfers in spinal cord injury. Review of the literature and the authors' cases series of 13 operations in nine spinal cord injury nerve transfer recipients was performed. Representative cases were reviewed to explore critical concepts and preliminary outcomes. The nerve transfers used expendable donors (e.g., teres minor, deltoid, supinator, and brachialis) innervated above the level of the spinal cord injury to restore volitional control of missing function such as elbow extension, wrist extension, and/or hand function (posterior interosseous nerve or anterior interosseous nerve/finger flexors reinnervated). Results from the literature and the authors' patients (after a mean postsurgical follow-up of 12 months) indicate gains in function as assessed by both manual muscle testing and patients' self-reported outcomes measures. Nerve transfers can provide an alternative and consistent means of reestablishing volitional control of upper extremity function in people with cervical level spinal cord injury. Early outcomes provide evidence of substantial improvements in self-reported function despite relatively subtle objective gains in isolated muscle strength. Further work to investigate the optimal timing and combination of nerve transfer operations, the combination of these with traditional treatments (tendon transfer and functional electrical stimulation), and measurement of outcomes is imperative for determining the precise role of these operations. Therapeutic, IV.

  19. Variability in the treatment of acute spinal cord injury in the United Kingdom: results of a national survey.

    Science.gov (United States)

    Werndle, Melissa C; Zoumprouli, Argyro; Sedgwick, Philip; Papadopoulos, Marios C

    2012-03-20

    The aim of this study was to examine how traumatic spinal cord injury is managed in the United Kingdom via a questionnaire survey of all neurosurgical units. We contacted consultant neurosurgeons and neuroanesthetists in all neurosurgical centers that manage patients with acute spinal cord injury. Two clinical scenarios-of complete and incomplete cervical spinal cord injuries-were given to determine local treatment policies. There were 175 responders from the 33 centers (36% response rate). We ascertained neurosurgical views on urgency of transfer, timing of surgery, nature and aim of surgery, as well as neuroanesthetic views on type of anesthetic, essential intraoperative monitoring, drug treatment, and intensive care management. Approximately 70% of neurosurgeons will admit patients with incomplete spinal cord injury immediately, but only 40% will admit patients with complete spinal cord injury immediately. There is no consensus on the timing or even the role of surgery for incomplete or complete injuries. Most (96%) neuroanesthetists avoid anesthetics known to elevate intracranial pressure. What was deemed essential intraoperative monitoring, however, varied widely. Many (22%) neuroanesthetists do not routinely measure arterial blood pressure invasively, central venous pressure (85%), or cardiac output (94%) during surgery. There is no consensus among neuroanesthetists on the optimal levels of arterial blood pressure, or oxygen and carbon dioxide partial arterial pressure. We report wide variability among U.K. neurosurgeons and neuroanesthetists in their treatment of acute traumatic spinal cord injury. Our findings reflect the lack of Class 1 evidence that early surgical decompression and intensive medical management of patients with spinal cord injury improves neurological outcome.

  20. THE EFFECT OF MONOSIALOGANGLYOSIDE (GM-1) ADMINISTRATION IN SPINAL CORD INJURY

    Science.gov (United States)

    BARROS, TARCÍSIO ELOY PESSOA; ARAUJO, FERNANDO FLORES DE; HIGINO, LUCAS DA PAZ; MARCON, RAPHAEL MARTUS; CRISTANTE, ALEXANDRE FOGAÇA

    2016-01-01

    ABSTRACT Objective: To evaluate the effect of monosialoganglioside (GM-1) in spinal cord trauma patients seen in our service who have not been treated with methylprednisolone. Methods: Thirty patients with acute spinal cord trauma were randomly divided into two groups. In Group 1, patients received 200 mg GM-1 in the initial assessment and thereafter received 100 mg intravenous per day for 30 days and Group 2 (control) received saline. Patients were evaluated periodically (at 6 weeks, 6 months, one year and two years), using a standardized neurological assessment of the American Spinal Injury Association / International Spinal Cord Society. Results: The comparative statistical analysis of motor indices, sensitive indices for pain and touch according to the standardization of ASIA / ISCOS showed that the assessments at 6 weeks, 6 months and 2 years, GM-Group 1 patients had higher rates than the control group regarding sensitivity to pain and touch, with no statistically significant difference from the motor index. Conclusion: The functional assessment showed improvement in the sensitive indices of patients treated with GM1 after post-traumatic spinal cord injury compared to patients who received placebo. Level of Evidence IV, Prospective Case Studies Series. PMID:27217811

  1. Spinal cord decompression reduces rat neural cell apoptosis secondary to spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    Kan XU; Qi-xin CHEN; Fang-cai LI; Wei-shan CHEN; Min LIN; Qiong-hua WET

    2009-01-01

    Objective: To determine whether spinal cord decompression plays a role in neural cell apoptosis after spinal cord injury. Study design: We used an animal model of compressive spinal cord injury with incomplete paraparesis to evaluate neural cell apoptosis after decompression. Apoptosis and cellular damage were assessed by staining with terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate nick-end labelling (TUNEL) and immunostaining for caspase-3, Bcl-2 and Bax. Methods: Experiments were conducted in male Spragne-Dawley rats (n=78) weighing 300-400 g. The spinal cord was compressed posteriorly at T10 level using a custom-made screw for 6 h, 24 h or continuously, followed by decompression by removal of the screw. The rats were sacrificed on Day 1 or 3 or in Week 1 or 4 post-decompression. The spinal cord was removed en bloc and examined at lesion site, rostral site and caudal site (7.5 mm away from the lesion). Results: The numbers of TUNEL-positive cells were significantly lower at the site of decompression on Day l, and also at the rostral and caudal sites between Day 3 and Week 4 post-decompression, compared with the persistently compressed group. The numbers of cells between Day 1 and Week 4 were immunoreactive to caspase-3 and B-cell lymphoma-2 (Bcl-2)-associated X-protein (Bax), but not to Bcl-2, correlated with those of TUNEL-positive cells. Conclusion: Our results suggest that decompression reduces neural cell apoptosis following spinal cord injury.

  2. Research progress of rehabilitation nursing for patients with spinal cord injury complicated by muscle spasm%脊髓损伤并发肌痉挛患者的康复护理研究进展

    Institute of Scientific and Technical Information of China (English)

    杨梅; 别明波

    2014-01-01

    肌痉挛是脊髓损伤患者常见并发症,可导致患者肢体酸胀疼痛、抽搐,关节挛缩、变形,增加异位骨化和骨折的发生率。目前的护理方法主要有体位护理、康复训练后护理、痉挛手术护理、康复心理护理等。本文回顾国内外肌痉挛康复护理有关文献,对脊髓损伤患者并发肌痉挛的康复护理方法、护理效果评估、护理注意事项等研究进展进行综述。%Muscle spasm is a common complication in patients with spinal cord injury. Spasticity can lead to limb swelling pain, convulsions, arthrogryposis, distortion and increase the incidence of heterotopic ossification and fracture. Current nursing methods in-clude postural care, care after rehabilitation training,rehabilitation care after psychological treatments and care after cramping surgery, and rehabilitation psychological nursing and the like. Through reviewing the rehabilitation nursing literatures on muscle spasm at home and abroad, this article discussed the methods, effects and notices of rehabilitation nursing on the patients with spinal cord injury com-plicated by muscle spasm.

  3. Common data elements for spinal cord injury clinical research

    DEFF Research Database (Denmark)

    Biering-Sørensen, F; Alai, S; Anderson, K.

    2015-01-01

    OBJECTIVES: To develop a comprehensive set of common data elements (CDEs), data definitions, case report forms and guidelines for use in spinal cord injury (SCI) clinical research, as part of the CDE project at the National Institute of Neurological Disorders and Stroke (NINDS) of the US National...... with and cross-referenced to development of the International Spinal Cord Society (ISCoS) International SCI Data Sets. The recommendations were compiled, subjected to internal review and posted online for external public comment. The final version was reviewed by all working groups and the NINDS CDE team before...

  4. Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management

    Directory of Open Access Journals (Sweden)

    Miguel L. Tedde

    2012-11-01

    Full Text Available OBJECTIVE: The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker. METHODS: Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov: NCT01385384. RESULTS: The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day. CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.

  5. Against the odds: what to expect in rehabilitation of chronic spinal cord injury with a neurologically controlled Hybrid Assistive Limb exoskeleton. A subgroup analysis of 55 patients according to age and lesion level.

    Science.gov (United States)

    Grasmücke, Dennis; Zieriacks, Amrei; Jansen, Oliver; Fisahn, Christian; Sczesny-Kaiser, Matthias; Wessling, Martin; Meindl, Renate C; Schildhauer, Thomas A; Aach, Mirko

    2017-05-01

    Objective Age and lesion level are believed to represent outcome predictors in rehabilitation of patients with chronic spinal cord injury (SCI). The Hybrid Assistive Limb (HAL) exoskeleton enables patients to perform a voluntary controlled gait pattern via an electromyography-triggered neuromuscular feedback system, and has been introduced as a temporary gait training tool in patients with SCI. The aim of this prospective pre- and postintervention study was to examine functional outcomes as a function of age and lesion level in patients with chronic incomplete SCI (iSCI) or chronic complete SCI (cSCI) with zones of partial preservation (ZPP) by using the HAL as a temporary training tool. Methods Fifty-five participants with chronic iSCI or cSCI (mean time since injury 6.85 ± 5.12 years) were classified according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) and divided by age (exoskeleton. An improvement of approximately 50% in the 10MWTsss and in gait endurance (6MinWT) can be expected from such training. The influences of SCI lesion level and age on functional outcome we