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Sample records for spinal manipulative therapy

  1. The effect of spinal manipulative therapy on spinal range of motion

    DEFF Research Database (Denmark)

    Millan, Mario; Leboeuf-Yde, Charlotte; Budgell, Brian

    2012-01-01

    Spinal manipulative therapy (SMT) has been shown to have an effect on spine-related pain, both clinically and in experimentally induced pain. However, it is unclear if it has an immediate noticeable biomechanical effect on spinal motion that can be measured in terms of an increased range of motion...

  2. Does the application site of spinal manipulative therapy alter spinal tissues loading?

    Science.gov (United States)

    Funabashi, Martha; Nougarou, François; Descarreaux, Martin; Prasad, Narasimha; Kawchuk, Gregory N

    2018-01-31

    Previous studies found that the intervertebral disc (IVD) experiences the greatest loads during spinal manipulation therapy (SMT). Based on that, this study aimed to determine if loads experienced by spinal tissues are significantly altered when the application site of SMT is changed. A biomechanical robotic serial dissection study. Thirteen porcine cadaveric motion segments. Forces experienced by lumbar spinal tissues. A servo-controlled linear actuator provided standardized 300 N SMT simulations to six different cutaneous locations of the porcine lumbar spine: L2-L3 and L3-L4 facet joints (FJ), L3 and L4 transverse processes (TVP), and the space between the FJs and the TVPs (BTW). Vertebral kinematics were tracked optically using indwelling bone pins; the motion segment was removed and mounted in a parallel robot equipped with a six-axis load cell. Movements of each SMT application at each site were replayed by the robot with the intact specimen and following the sequential removal of spinal ligaments, FJs and IVD. Forces induced by SMT were recorded, and specific axes were analyzed using linear mixed models. Analyses yielded a significant difference (p<.05) in spinal structures loads as a function of the application site. Spinal manipulative therapy application at the L3 vertebra caused vertebral movements and forces between L3 and L4 spinal segment in the opposite direction to when SMT was applied at L4 vertebra. Additionally, SMT applications over the soft tissue between adjacent vertebrae significantly decreased spinal structure loads. Applying SMT with a constant force at different spinal levels creates different relative kinetics of the spinal segments and load spinal tissues in significantly different magnitudes. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Effect of Spinal Manipulative Therapy on the Singing Voice.

    Science.gov (United States)

    Fachinatto, Ana Paula A; Duprat, André de Campos; Silva, Marta Andrada E; Bracher, Eduardo Sawaya Botelho; Benedicto, Camila de Carvalho; Luz, Victor Botta Colangelo; Nogueira, Maruan Nogueira; Fonseca, Beatriz Suster Gomes

    2015-09-01

    This study investigated the effect of spinal manipulative therapy (SMT) on the singing voice of male individuals. Randomized, controlled, case-crossover trial. Twenty-nine subjects were selected among male members of the Heralds of the Gospel. This association was chosen because it is a group of persons with similar singing activities. Participants were randomly assigned to two groups: (A) chiropractic SMT procedure and (B) nontherapeutic transcutaneous electrical nerve stimulation (TENS) procedure. Recordings of the singing voice of each participant were taken immediately before and after the procedures. After a 14-day period, procedures were switched between groups: participants who underwent SMT on the first day were subjected to TENS and vice versa. Recordings were subjected to perceptual audio and acoustic evaluations. The same recording segment of each participant was selected. Perceptual audio evaluation was performed by a specialist panel (SP). Recordings of each participant were randomly presented thus making the SP blind to intervention type and recording session (before/after intervention). Recordings compiled in a randomized order were also subjected to acoustic evaluation. No differences in the quality of the singing on perceptual audio evaluation were observed between TENS and SMT. No differences in the quality of the singing voice of asymptomatic male singers were observed on perceptual audio evaluation or acoustic evaluation after a single spinal manipulative intervention of the thoracic and cervical spine. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  4. Spinal Tissue Loading Created by Different Methods of Spinal Manipulative Therapy Application.

    Science.gov (United States)

    Funabashi, Martha; Nougarou, François; Descarreaux, Martin; Prasad, Narasimha; Kawchuk, Gregory N

    2017-05-01

    Comparative study using robotic replication of spinal manipulative therapy (SMT) vertebral kinematics together with serial dissection. The aim of this study was to quantify loads created in cadaveric spinal tissues arising from three different forms of SMT application. There exist many distinct methods by which to apply SMT. It is not known presently whether different forms of SMT application have different effects on spinal tissues. Should the method of SMT application modulate spinal tissue loading, quantifying this relation may help explain the varied outcomes of SMT in terms of effect and safety. SMT was applied to the third lumbar vertebra in 12 porcine cadavers using three SMT techniques: a clinical device that applies forces through a hand-held instrument (INST), a manual technique of applying SMT clinically (MAN) and a research device that applies parameters of manual SMT through a servo-controlled linear actuator motor (SERVO). The resulting kinematics from each SMT application were tracked optically via indwelling bone pins. The L3/L4 segment was then removed, mounted in a parallel robot and the resulting kinematics from SMT replayed for each SMT application technique. Serial dissection of spinal structures was conducted to quantify loading characteristics of discrete spinal tissues. In terms of load magnitude, SMT application with MAN and SERVO created greater forces than INST in all conditions (P < 0.05). Additionally, MAN and SERVO created comparable posterior forces in the intact specimen, but MAN created greater posterior forces on IVD structures compared to SERVO (P < 0.05). Specific methods of SMT application create unique vertebral loading characteristics, which may help explain the varied outcomes of SMT in terms of effect and safety. N/A.

  5. Spinal Manipulative Therapy and Exercise for Seniors with Chronic Neck Pain

    DEFF Research Database (Denmark)

    Maiers, Michele; Bronfort, Gert; Evans, Roni

    2014-01-01

    Neck pain, common among the elderly population, has considerable implications on health and quality of life. Evidence supports the use of spinal manipulative therapy and exercise to treat neck pain; however, no studies to date have evaluated the effectiveness of these therapies specifically in se...... in seniors....

  6. EVALUATING THE TARGET, EFFECT, ACTION INTERACTION (TEA MODEL OF SPINAL MANIPULATION THERAPY ON SACROILIAC JOINT DYSFUNCTION

    Directory of Open Access Journals (Sweden)

    Muhammad Salman Bashir

    2017-08-01

    Full Text Available Background: In physical therapy, usually the effects of treatment on any condition will be evaluated based on the mode of action on the target tissue. Some treatments will have direct and indirect effects. Due to indirect effects, there may be changes in other tissues or systems in and around the target tissue. The interaction between target, effect, and action was studied under TEA model. In sacroiliac joint dysfunction, Muscle Energy Technique (MET and Spinal Manipulation Therapy (SMT were proved as useful treatment approaches but one is targeted on muscles (MET the other targets on joint (SMT. The indirect effects of both the approaches can’t be neglected. This study focused on evaluating indirect effects of SMT. Methods: A pilot study was conducted to see the effect of Spinal Manipulation Therapy on muscles (Transverse Abdominus, Internal Oblique when applied in patients with sacroiliac joint dysfunction. 44 subjects diagnosed with sacroiliac joint dysfunction were recruited in the study. Resting thickness was measured by ultrasound before and after Spinal Manipulation Therapy. SPSS version 17 was used for statistical analysis. Paired t-test compared pre and post test results. Results: After conducting Pilot study revealed that Pre resting thickness of Transverse Abdominus and Internal Oblique is (3.5±0.10 and (5.47± 0.15 Post resting Thickness of TrA (Transverse Abdominus and Internal Oblique (IO is (3.90±0.12 and (7.63±0.80 Results are significant as P-Value 0.000 that is <0.05. Conclusion: Here is concluded that SMT is a useful method to treat muscles through its direct action is on the Sacroiliac joint in Sacroiliac joint dysfunction. So we can use it for treating muscles by applying on joints (Indirect method.

  7. Influence of Spinal Manipulative Therapy Force Magnitude and Application Site on Spinal Tissue Loading: A Biomechanical Robotic Serial Dissection Study in Porcine Motion Segments.

    Science.gov (United States)

    Funabashi, Martha; Nougarou, François; Descarreaux, Martin; Prasad, Narasimha; Kawchuk, Greg

    In order to define the relation between spinal manipulative therapy (SMT) input parameters and the distribution of load within spinal tissues, the aim of this study was to determine the influence of force magnitude and application site when SMT is applied to cadaveric spines. In 10 porcine cadavers, a servo-controlled linear actuator motor provided a standardized SMT simulation using 3 different force magnitudes (100N, 300N, and 500N) to 2 different cutaneous locations: L3/L4 facet joint (FJ), and L4 transverse processes (TVP). Vertebral kinematics were tracked optically using indwelling bone pins, the motion segment removed and mounted in a parallel robot equipped with a 6-axis load cell. The kinematics of each SMT application were replicated robotically. Serial dissection of spinal structures was conducted to quantify loading characteristics of discrete spinal tissues. Forces experienced by the L3/L4 segment and spinal structures during SMT replication were recorded and analyzed. Spinal manipulative therapy force magnitude and application site parameters influenced spinal tissues loading. A significant main effect (P < .05) of force magnitude was observed on the loads experienced by the intact specimen and supra- and interspinous ligaments. The main effect of application site was also significant (P < .05), influencing the loading of the intact specimen and facet joints, capsules, and ligamentum flavum (P < .05). Spinal manipulative therapy input parameters of force magnitude and application site significantly influence the distribution of forces within spinal tissues. By controlling these SMT parameters, clinical outcomes may potentially be manipulated. Copyright © 2017. Published by Elsevier Inc.

  8. Spinal Manipulative Therapy Specific Changes In Pain Sensitivity In Individuals With Low Back Pain (NCT01168999)

    Science.gov (United States)

    Bialosky, Joel E; George, Steven Z; Horn, Maggie E; Price, Donald D; Staud, Roland; Robinson, Michael E

    2013-01-01

    Spinal Manipulative Therapy (SMT) is effective for some individuals experiencing low back pain (LBP); however, the mechanisms are not established regarding the role of placebo. SMT is associated with changes in pain sensitivity suggesting related altered central nervous system response or processing of afferent nociceptive input. Placebo is also associated with changes in pain sensitivity and the efficacy of SMT for changes in pain sensitivity beyond placebo has not been adequately considered. We randomly assigned 110 participants with LBP to receive SMT, placebo SMT, placebo SMT with the instructional set, “The manual therapy technique you will receive has been shown to significantly reduce low back pain in some people”, or no intervention. Participants receiving the SMT and placebo SMT received their assigned intervention 6 times over two weeks. Pain sensitivity was assessed prior to and immediately following the assigned intervention during the first session. Clinical outcomes were assessed at baseline and following two weeks of participation in the study. Immediate attenuation of suprathreshold heat response was greatest following SMT (p= 0.05, partial η2= 0.07). Group dependent differences were not observed for changes in pain intensity and disability at two week. Participant satisfaction was greatest following the enhanced placebo SMT. PMID:24361109

  9. Adverse events after cervical spinal manipulative therapy: consensus based classification and definitions

    NARCIS (Netherlands)

    Dr. C.P. van der Schans; M. Schmitt; dr. S.E. Lakke; H.A. Kranenburg

    2015-01-01

    Cervical spinal manipulations (CSM) are frequently employed techniques to alleviate neck pain and headache. Minor and major complications following CSM have been described, though clear consensus on definition and the classification of the complications had not yet been achieved. As a result,

  10. Adverse events after cervical spinal manipulative therapy: consensus based classification and definitions

    NARCIS (Netherlands)

    Kranenburg, Rik; Jorna-Lakke, Sandra; Schmitt, M.A.; van der Schans, Cees

    2016-01-01

    Cervical spinal manipulations (CSM) are frequently employed techniques to alleviate neck pain and headache. Minor and major complications following CSM have been described, though clear consensus on definition and the classification of the complications had not yet been achieved. As a result,

  11. Complications of spinal manipulation : A comprehensive review of the literature

    NARCIS (Netherlands)

    Assendelft, Willem J.J.; Bouter, Lex M.; Knipschild, Paul G.

    1996-01-01

    Background. Spinal manipulative therapy (SMT) is a frequently applied therapy for back and neck pain. Serious complications of SMT are presented primarily in case reports. Many patients seen by physicians also seek care from therapists applying manipulative techniques. Therefore, background

  12. The risk associated with spinal manipulation

    DEFF Research Database (Denmark)

    Nielsen, Sabrina Mai; Tarp, Simon; Christensen, Robin

    2017-01-01

    BACKGROUND: Spinal manipulative therapy (SMT) is a widely used manual treatment, but many reviews exist with conflicting conclusions about the safety of SMT. We performed an overview of reviews to elucidate and quantify the risk of serious adverse events (SAEs) associated with SMT. METHODS: We...

  13. Cervical Intradural Disc Herniation Causing Progressive Quadriparesis After Spinal Manipulation Therapy: A Case Report and Literature Review.

    Science.gov (United States)

    Yang, Hwan-Seo; Oh, Young-Min; Eun, Jong-Pil

    2016-02-01

    Cervical intradural disc herniation (IDH) is an extremely rare condition, comprising only 0.27% of all disc herniations. Three percent of IDHs occur in the cervical, 5% in the thoracic, and over 92% in the lumbar spinal canal. There have been a total of 31 cervical IDHs reported in the literature. The pathogenesis and imaging characteristics of IDH are not fully understood. A preoperative diagnosis is key to facilitating prompt intradural exploration in patients with ambivalent findings, as well as in preventing reoperation. The purpose of reporting our case is to remind clinicians to consider the possibility of cervical IDH during spinal manipulation therapy in patient with chronic neck pain.The patient signed informed consent for publication of this case report and any accompanying image. The ethical approval of this study was waived by the ethics committee of Chonbuk National University Hospital, because this study was case report and the number of patients was manipulation for chronic neck pain over the course of a month. The day prior, he had noticed neck pain and tingling in the bilateral upper and lower extremities during the manipulation procedure. The following day, he presented with bilateral weakness of all 4 extremities, which rendered him unable to walk. Neurological examination demonstrated a positive Hoffmann sign and ankle clonus bilaterally, hypoesthesia below the C5 dermatome, 3/5 strength in the bilateral upper extremities, and 2/5 strength in the lower extremities. This motor weakness was progressive, and he further complained of voiding difficulty.Urgent magnetic resonance imaging (MRI) of the cervical spine revealed large, central disc herniations at C4-C5 and C5-C6 that caused severe spinal cord compression and surrounding edema. We performed C4-C5-C6 anterior cervical discectomy and fusion.The patient's limb weakness improved rapidly within 1 day postoperatively, and he was discharged 4 weeks later. At his 12-month follow-up, the patient had

  14. Improvement of lower extremity electrodiagnostic findings following a trial of spinal manipulation and motion-based therapy

    Directory of Open Access Journals (Sweden)

    Morningstar Mark W

    2006-09-01

    Full Text Available Abstract Background Lumbar disc herniation is a problem frequently encountered in manual medicine. While manual therapy has shown reasonable success in symptomatic management of these cases, little information is known how manual therapy may affect the structure and function of the lumbar disc itself. In cases where lumbar disc herniation is accompanied by radicular symptoms, electrodiagnostic testing has been used to provide objective clinical information on nerve function. This report examines the treatment rendered for a patient with lower extremity neurological deficit, as diagnosed on electrodiagnostic testing. Patient was treated using spinal manipulation and exercises performed on a Pettibon Wobble Chair™, using electrodiagnostic testing as the primary outcome assessment. Case Presentation An elderly male patient presented to a private spine clinic with right-sided foot drop. He had been prescribed an ankle-foot orthosis for this condition. All sensory, motor, and reflex findings in the right leg and foot were absent. This was validated on prior electromyography and nerve conduction velocity testing, performed by a board certified neurologist. Patient was treated using spinal manipulation twice-weekly and wobble chair exercises three times daily for 90 days total. Following this treatment, the patient was referred for follow-up electrodiagnostic studies. Significant improvements were made in these studies as well as self-rated daily function. Conclusion Motion-based therapies, as part of a comprehensive rehabilitation program, may contribute to the restoration of daily function and the reversal of neurological insult as detected by electrodiagnostic testing. Electrodiagnostic testing may be a useful clinical tool to evaluate the progress of chiropractic patients with lumbar disc herniation and radicular pain syndromes.

  15. Rational and design of an individual participant data meta-analysis of spinal manipulative therapy for chronic low back pain-a protocol

    NARCIS (Netherlands)

    de Zoete, A; de Boer, M R; van Tulder, M W; Rubinstein, S M; Underwood, M.; Hayden, J.A.; Kalter, J.; Ostelo, R

    2017-01-01

    BACKGROUND: Chronic low back pain (LBP) is the leading cause of pain and disability, resulting in a major socioeconomic impact. The Cochrane Review which examined the effect of spinal manipulative therapy (SMT) for chronic LBP concluded that SMT is moderately effective, but was based on conventional

  16. Conservative care with or without manipulative therapy in the management of spinal pain in Danish children aged 9-15. A randomized controlled trial

    DEFF Research Database (Denmark)

    Dissing, Kristina Boe; Hartvigsen, Jan; Wedderkopp, Niels

    pain is transient and trivial for most children, some are severely affected with recurrent and bothersome complaints. Therefore, it is of great importance to focus on approaches to diminish the amount of recurrent events of spinal pain and the potential long-term effects. In this trial we investigated......Background Today, no ‘gold standard’ treatment for spinal pain in children exists, but manipulative therapy (MT) is widely used, both alone and in combination with other types of therapy such as exercise and soft tissue treatment, in spite of lack of evidence for effectiveness in children. The use...... of MT on children is mostly based on clinical experience as well as knowledge from guidelines for adults. Thus, it appears essential to investigate the effect on children of this widely used treatment and thereby gain more solid evidence about management of children with spinal pain. Although spinal...

  17. Efficacy of spinal manipulation for chronic headache: A systematic review

    NARCIS (Netherlands)

    Bronfort, Gert; Assendelft, Willem J.J.; Evans, Roni; Haas, Mitchell; Bouter, Lex

    2001-01-01

    Background: Chronic headache is a prevalent condition with substantial socioeconomic impact. Complementary or alternative therapies are increasingly being used by patients to treat headache pain, and spinal manipulative therapy (SMT) is among the most common of these. Objective: To assess the

  18. Spinal Manipulation for Low-Back Pain

    Science.gov (United States)

    ... V W X Y Z Spinal Manipulation for Low-Back Pain Share: On This Page Introduction Key Points About ... will help ensure coordinated and safe care. About Low-Back Pain Back pain is one of the most common ...

  19. Cost-effectiveness of spinal manipulative therapy, supervised exercise, and home exercise for older adults with chronic neck pain.

    Science.gov (United States)

    Leininger, Brent; McDonough, Christine; Evans, Roni; Tosteson, Tor; Tosteson, Anna N A; Bronfort, Gert

    2016-11-01

    Chronic neck pain is a prevalent and disabling condition among older adults. Despite the large burden of neck pain, little is known regarding the cost-effectiveness of commonly used treatments. This study aimed to estimate the cost-effectiveness of home exercise and advice (HEA), spinal manipulative therapy (SMT) plus HEA, and supervised rehabilitative exercise (SRE) plus HEA. Cost-effectiveness analysis conducted alongside a randomized clinical trial (RCT) was performed. A total of 241 older adults (≥65 years) with chronic mechanical neck pain comprised the patient sample. The outcome measures were direct and indirect costs, neck pain, neck disability, SF-6D-derived quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) over a 1-year time horizon. This work was supported by grants from the National Center for Complementary and Integrative Health (#F32AT007507), National Institute of Arthritis and Musculoskeletal and Skin Diseases (#P60AR062799), and Health Resources and Services Administration (#R18HP01425). The RCT is registered at ClinicalTrials.gov (#NCT00269308). A societal perspective was adopted for the primary analysis. A healthcare perspective was adopted as a sensitivity analysis. Cost-effectivenesswas a secondary aim of the RCT which was not powered for differences in costs or QALYs. Differences in costs and clinical outcomes were estimated using generalized estimating equations and linear mixed models, respectively. Cost-effectiveness acceptability curves were calculated to assess the uncertainty surrounding cost-effectiveness estimates. Total costs for SMT+HEA were 5% lower than HEA (mean difference: -$111; 95% confidence interval [CI] -$1,354 to $899) and 47% lower than SRE+HEA (mean difference: -$1,932; 95% CI -$2,796 to -$1,097). SMT+HEA also resulted in a greater reduction of neck pain over the year relative to HEA (0.57; 95% CI 0.23 to 0.92) and SRE+HEA (0.41; 95% CI 0.05 to 0.76). Differences in disability and

  20. Effect of spinal manipulative therapy with stretching compared with stretching alone on full-swing performance of golf players: a randomized pilot trial☆

    Science.gov (United States)

    Costa, Soraya M.V.; Chibana, Yumi E.T.; Giavarotti, Leandro; Compagnoni, Débora S.; Shiono, Adriana H.; Satie, Janice; Bracher, Eduardo S.B.

    2009-01-01

    Abstract Objective There has been a steady growth of chiropractic treatment using spinal manipulative therapy (SMT) that aims to increase the performance of athletes in various sports. This study evaluates the effect of SMT by chiropractors on the performance of golf players. Methods Golfers of 2 golf clubs in São Paulo, Brazil, participated in this study. They were randomized to 1 of 2 groups: Group I received a stretch program, and group II received a stretch program in addition to SMT. Participants in both groups performed the same standardized stretching program. Spinal manipulative therapy to dysfunctional spinal segments was performed on group II only. All golfers performed 3 full-swing maneuvers. Ball range was considered as the average distance for the 3 shots. Treatment was performed after the initial measurement, and the same maneuvers were performed afterward. Each participant repeated these procedures for a 4-week period. Student t test, Mann-Whitney nonparametric test, and 1-way analysis of variance for repeated measures with significance level of 5% were used to analyze the study. Results Forty-three golfers completed the protocol. Twenty participants were allocated to group I and 23 to group II. Average age, handicap, and initial swing were comparable. No improvement of full-swing performance was observed during the 4 sessions on group I (stretch only). An improvement was observed at the fourth session of group II (P = .005); when comparing the posttreatment, group II had statistical significance at all phases (P = .003). Conclusions Chiropractic SMT in association with muscle stretching may be associated with an improvement of full-swing performance when compared with muscle stretching alone. PMID:19948307

  1. Review conclusions by Ernst and Canter regarding spinal manipulation refuted

    Directory of Open Access Journals (Sweden)

    Evans Roni

    2006-08-01

    Full Text Available Abstract In the April 2006 issue of the Journal of Royal Society of Medicine, Ernst and Canter authored a review of the most recent systematic reviews on the effectiveness of spinal manipulation for any condition. The authors concluded that, except for back pain, spinal manipulation is not an effective intervention for any condition and, because of potential side effects, cannot be recommended for use at all in clinical practice. Based on a critical appraisal of their review, the authors of this commentary seriously challenge the conclusions by Ernst and Canter, who did not adhere to standard systematic review methodology, thus threatening the validity of their conclusions. There was no systematic assessment of the literature pertaining to the hazards of manipulation, including comparison to other therapies. Hence, their claim that the risks of manipulation outweigh the benefits, and thus spinal manipulation cannot be recommended as treatment for any condition, was not supported by the data analyzed. Their conclusions are misleading and not based on evidence that allow discrediting of a large body of professionals using spinal manipulation.

  2. Review: An Overview of Spinal Manipulation and Mobilization Effects

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    Behnam Akhbari

    2007-07-01

    Full Text Available Manipulation and mobilization are two different forms of manual therapy commonly employed in the management of musculoskeletal disorders. Spinal manipulation and mobilization are often distinguished from one another by reference to certain biomechanical parameters such as peak force, duration and magnitude of translation. However, as of yet, there is relatively little research which distinguishes between them in terms of neurological mechanisms or clinical effectiveness. Manipulation may particularly stimulate receptors within deep inter-vertebral muscles, while mobilization techniques most likely affect more superficial axial muscles.

  3. Determining the Optimal Number of Spinal Manipulation Sessions for Chronic Low-Back Pain

    Science.gov (United States)

    ... Optimal Number of Spinal Manipulation Sessions for Chronic Low-Back Pain Share: © Matthew Lester Findings from the largest and ... study of spinal manipulative therapy (SMT) for chronic low-back pain suggest that 12 sessions (SMT) may be the ...

  4. Adverse events among seniors receiving spinal manipulation and exercise in a randomized clinical trial

    DEFF Research Database (Denmark)

    Maiers, Michele; Evans, Roni; Hartvigsen, Jan

    2015-01-01

    Spinal manipulative therapy (SMT) and exercise have demonstrated effectiveness for neck pain (NP). Adverse events (AE) reporting in trials, particularly among elderly participants, is inconsistent and challenges informed clinical decision making. This paper provides a detailed report of AE experi...

  5. Predicting a clinically important outcome in patients with low back pain following McKenzie therapy or spinal manipulation

    DEFF Research Database (Denmark)

    Petersen, Tom; Christensen, Robin; Juhl, Carsten Bogh

    2015-01-01

    Background: Reports vary considerably concerning characteristics of patients who will respond to mobilizing exercises or manipulation. The objective of this prospective cohort study was to identify characteristics of patients with a changeable lumbar condition, i.e. presenting with centralization...

  6. Glucose Metabolic Changes in the Brain and Muscles of Patients with Nonspecific Neck Pain Treated by Spinal Manipulation Therapy: A [18F]FDG PET Study

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    Akie Inami

    2017-01-01

    Full Text Available Objective. The aim of this study was to investigate changes in brain and muscle glucose metabolism that are not yet known, using positron emission tomography with [18F]fluorodeoxyglucose ([18F]FDG PET. Methods. Twenty-one male volunteers were recruited for the present study. [18F]FDG PET scanning was performed twice on each subject: once after the spinal manipulation therapy (SMT intervention (treatment condition and once after resting (control condition. We performed the SMT intervention using an adjustment device. Glucose metabolism of the brain and skeletal muscles was measured and compared between the two conditions. In addition, we measured salivary amylase level as an index of autonomic nervous system (ANS activity, as well as muscle tension and subjective pain intensity in each subject. Results. Changes in brain activity after SMT included activation of the dorsal anterior cingulate cortex, cerebellar vermis, and somatosensory association cortex and deactivation of the prefrontal cortex and temporal sites. Glucose uptake in skeletal muscles showed a trend toward decreased metabolism after SMT, although the difference was not significant. Other measurements indicated relaxation of cervical muscle tension, decrease in salivary amylase level (suppression of sympathetic nerve activity, and pain relief after SMT. Conclusion. Brain processing after SMT may lead to physiological relaxation via a decrease in sympathetic nerve activity.

  7. Spinal manipulative therapy versus Graston Technique in the treatment of non-specific thoracic spine pain: Design of a randomised controlled trial

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    Walker Bruce

    2008-10-01

    Full Text Available Abstract Background The one year prevalence of thoracic back pain has been estimated as 17% compared to 64% for neck pain and 67% for low back pain. At present only one randomised controlled trial has been performed assessing the efficacy of spinal manipulative therapy (SMT for thoracic spine pain. In addition no high quality trials have been performed to test the efficacy and effectiveness of Graston Technique® (GT, a soft tissue massage therapy using hand-held stainless steel instruments. The objective of this trial is to determine the efficacy of SMT and GT compared to a placebo for the treatment of non specific thoracic spine pain. Methods Eighty four eligible people with non specific thoracic pain mid back pain of six weeks or more will be randomised to one of three groups, either SMT, GT, or a placebo (de-tuned ultrasound. Each group will receive up to 10 supervised treatment sessions at the Murdoch University Chiropractic student clinic over a 4-week period. Treatment outcomes will be measured at baseline, one week after their first treatment, upon completion of the 4-week intervention period and at three, six and twelve months post randomisation. Outcome measures will include the Oswestry Back Pain Disability Index and the Visual Analogue Scale (VAS. Intention to treat analysis will be utilised in the statistical analysis of any group treatment effects. Trial Registration This trial was registered with the Australia and New Zealand Clinical Trials Registry on the 7th February 2008. Trial number: ACTRN12608000070336

  8. Why do spinal manipulation techniques take the form they do? Towards a general model of spinal manipulation.

    Science.gov (United States)

    Evans, David W

    2010-06-01

    For centuries, techniques used to manipulate joints in the spine have been passed down from one generation of manipulators to the next. Today, spinal manipulation is in the curious position that positive clinical effects have now been demonstrated, yet the theoretical base underpinning every aspect of its use is still underdeveloped. An important question is posed in this masterclass: why do spinal manipulation techniques take the form they do? From the available literature, two factors appear to provide an answer: 1. Action of a force upon vertebrae. Any 'direct' spinal manipulation technique requires that the patient be orientated in such a way that force is applied perpendicular to the overlying skin surface so as to act upon the vertebrae beneath. If the vertebral motion produced by 'directly' applied force is insufficient to produce the desired effect (e.g. cavitation), then force must be applied 'indirectly', often through remote body segments such as the head, thorax, abdomen, pelvis, and extremities. 2. Spinal segment morphology. A new hypothesis is presented. Spinal manipulation techniques exploit the morphology of vertebrae by inducing rotation at a spinal segment, about an axis that is always parallel to the articular surfaces of the constituent zygapophysial joints. In doing so, the articular surfaces of one zygapophysial joint appose to the point of contact, resulting in migration of the axis of rotation towards these contacting surfaces, and in turn this facilitates gapping of the other (target) zygapophysial joint. Other variations in the form of spinal manipulation techniques are likely to depend upon the personal style and individual choices of the practitioner.

  9. Chiropractic manipulative therapy of the thoracic spine in ...

    African Journals Online (AJOL)

    Kim Castello Branco

    postural kyphosis but Group 2's treatment protocol, consisting of chiropractic spinal manipulative therapy to ... In older women (twenty five to forty five years of age), the increased .... angle of kyphosis measured, which had to fall within the angle of ... with the application of a controlled force, leverage, direction and velocity to ...

  10. Tissue loading created during spinal manipulation in comparison to loading created by passive spinal movements.

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    Funabashi, Martha; Kawchuk, Gregory N; Vette, Albert H; Goldsmith, Peter; Prasad, Narasimha

    2016-12-01

    Spinal manipulative therapy (SMT) creates health benefits for some while for others, no benefit or even adverse events. Understanding these differential responses is important to optimize patient care and safety. Toward this, characterizing how loads created by SMT relate to those created by typical motions is fundamental. Using robotic testing, it is now possible to make these comparisons to determine if SMT generates unique loading scenarios. In 12 porcine cadavers, SMT and passive motions were applied to the L3/L4 segment and the resulting kinematics tracked. The L3/L4 segment was removed, mounted in a parallel robot and kinematics of SMT and passive movements replayed robotically. The resulting forces experienced by L3/L4 were collected. Overall, SMT created both significantly greater and smaller loads compared to passive motions, with SMT generating greater anterioposterior peak force (the direction of force application) compared to all passive motions. In some comparisons, SMT did not create significantly different loads in the intact specimen, but did so in specific spinal tissues. Despite methodological differences between studies, SMT forces and loading rates fell below published injury values. Future studies are warranted to understand if loading scenarios unique to SMT confer its differential therapeutic effects.

  11. The effect of spinal manipulation on imbalances in leg strength.

    Science.gov (United States)

    Chilibeck, Philip D; Cornish, Stephen M; Schulte, Al; Jantz, Nathan; Magnus, Charlene R A; Schwanbeck, Shane; Juurlink, Bernhard H J

    2011-09-01

    We hypothesized that spinal manipulation (SM) would reduce strength imbalances between legs. Using an un-blinded randomized design, 28 males and 21 females (54 ± 19y) with at least a 15% difference in isometric strength between legs for hip flexion, extension, abduction, or knee flexion were randomized to treatment or placebo (mock spinal manipulation). Strength of the stronger and weaker legs for hip flexion, extension, abduction, and/or knee flexion was assessed before and after the intervention. SM reduced the relative strength difference between legs for knee flexion (mean ± SD 57 ± 53 to 5 ± 14%) and hip flexion (24 ± 12 to 11 ± 15%) compared to placebo (34 ± 29 to 24 ± 36%, and 20 ± 18 to 22 ± 26%, respectively) (p = 0.05). SM also improved strength in the weak leg for hip abduction (104 ± 43 to 116 ± 43 Nm) compared to placebo (84 ± 24 to 85 ± 31 Nm) (p = 0.03). This study suggests that spinal manipulation may reduce imbalances in strength between legs for knee and hip flexion.

  12. Beliefs in the population about cracking sounds produced during spinal manipulation.

    Science.gov (United States)

    Demoulin, Christophe; Baeri, Damien; Toussaint, Geoffrey; Cagnie, Barbara; Beernaert, Axel; Kaux, Jean-François; Vanderthommen, Marc

    2018-03-01

    To examine beliefs about cracking sounds heard during high-velocity low-amplitude (HVLA) thrust spinal manipulation in individuals with and without personal experience of this technique. We included 100 individuals. Among them, 60 had no history of spinal manipulation, including 40 who were asymptomatic with or without a past history of spinal pain and 20 who had nonspecific spinal pain. The remaining 40 patients had a history of spinal manipulation; among them, 20 were asymptomatic and 20 had spinal pain. Participants attended a one-on-one interview during which they completed a questionnaire about their history of spinal manipulation and their beliefs regarding sounds heard during spinal manipulation. Mean age was 43.5±15.4years. The sounds were ascribed to vertebral repositioning by 49% of participants and to friction between two vertebras by 23% of participants; only 9% of participants correctly ascribed the sound to the formation of a gas bubble in the joint. The sound was mistakenly considered to indicate successful spinal manipulation by 40% of participants. No differences in beliefs were found between the groups with and without a history of spinal manipulation. Certain beliefs have documented adverse effects. This study showed a high prevalence of unfounded beliefs regarding spinal manipulation. These beliefs deserve greater attention from healthcare providers, particularly those who practice spinal manipulation. Copyright © 2017 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  13. Low back pain and its treatment by spinal manipulation: measures of flexibility and asymmetry.

    Science.gov (United States)

    Hoehler, F K; Tobis, J S

    1982-02-01

    Nineteen low back pain patients and eight patients not suffering from low back pain were given several tests of flexibility and asymmetry by two different examiners. Three criteria of reliability and validity were used: (1) significant agreement between independent observers, (2) significantly different scores in the groups with and without low back pain, and (3) significant improvement following a successful spinal manipulation. Tests of anterior flexion and asymmetry of foot eversion met only the first and second criteria while tests of hamstring tightness and asymmetry of voluntary straight leg raising met only the first and third criteria. Passive and voluntary straight leg raising tests were the only measures that met all three criteria. Therefore, of the objective tests investigated here, only passive or voluntary straight leg raising can be strongly recommended for use in the evaluation of spinal manipulative therapy for low back pain.

  14. Learning spinal manipulation: A best-evidence synthesis of teaching methods.

    Science.gov (United States)

    Stainsby, Brynne E; Clarke, Michelle C S; Egonia, Jade R

    2016-10-01

    The purpose of this study was to evaluate the effectiveness of different reported methods used to teach spinal manipulative therapy to chiropractic students. For this best-evidence literature synthesis, 5 electronic databases were searched from 1900 to 2015. Eligible studies were critically appraised using the criteria of the Scottish Intercollegiate Guidelines Network. Scientifically admissible studies were synthesized following best-evidence synthesis principles. Twenty articles were critically appraised, including 9 randomized clinical trials, 9 cohort studies, and 2 systematic reviews/meta-analyses. Eleven articles were accepted as scientifically admissible. The type of teaching method aids included a Thrust in Motion cervical manikin, instrumented cardiopulmonary reanimation manikin, padded contact with a load cell, instrumented treatment table with force sensor/transducer, and Dynadjust instrument. Several different methods exist in the literature for teaching spinal manipulative therapy techniques; however, future research in this developing area of chiropractic education is proposed. It is suggested that various teaching methods be included in the regular curricula of chiropractic colleges to aid in developing manipulation skills, efficiency, and knowledge of performance.

  15. Spinal manipulation and mobilisation for back and neck pain : A blinded review

    NARCIS (Netherlands)

    Koes, B. W.; Assendelft, W. J J; Van Der Heijden, G. J M G; Bouter, L. M.; Knipschild, P. G.

    1991-01-01

    Objective - To assess the efficacy of spinal manipulation for patients with back or neck pain. Design - Computer aided search for published papers and blinded assessment of the methods of the studies. Subjects - 35 randomised clinical trials comparing spinal manipulation with other treatments. Main

  16. Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain

    DEFF Research Database (Denmark)

    Bronfort, Gert; Hondras, Maria; Schulz, Craig A

    2014-01-01

    BACKGROUND: Back-related leg pain (BRLP) is often disabling and costly, and there is a paucity of research to guide its management. OBJECTIVE: To determine whether spinal manipulative therapy (SMT) plus home exercise and advice (HEA) compared with HEA alone reduces leg pain in the short and long....... LIMITATION: Patients and providers could not be blinded. CONCLUSION: For patients with BRLP, SMT plus HEA was more effective than HEA alone after 12 weeks, but the benefit was sustained only for some secondary outcomes at 52 weeks. PRIMARY FUNDING SOURCE: U.S. Department of Health and Human Services....

  17. Drug therapy in spinal tuberculosis.

    Science.gov (United States)

    Rajasekaran, S; Khandelwal, Gaurav

    2013-06-01

    Although the discovery of effective anti-tuberculosis drugs has made uncomplicated spinal tuberculosis a medical disease, the advent of multi-drug-resistant Mycobacterium tuberculosis and the co-infection of HIV with tuberculosis have led to a resurgence of the disease recently. The principles of drug treatment of spinal tuberculosis are derived from our experience in treating pulmonary tuberculosis. Spinal tuberculosis is classified to be a severe form of extrapulmonary tuberculosis and hence is included in Category I of the WHO classification. The tuberculosis bacilli isolated from patients are of four different types with different growth kinetics and metabolic characteristics. Hence multiple drugs, which act on the different groups of the mycobacteria, are included in each anti-tuberculosis drug regimen. Prolonged and uninterrupted chemotherapy (which may be 'short course' and 'intermittent' but preferably 'directly observed') is effective in controlling the infection. Spinal Multi-drug-resistant TB and spinal TB in HIV-positive patients present unique problems in management and have much poorer prognosis. Failure of chemotherapy and emergence of drug resistance are frequent due to the failure of compliance hence all efforts must be made to improve patient compliance to the prescribed drug regimen.

  18. Radiation therapy for metastatic spinal tumors

    International Nuclear Information System (INIS)

    Kida, Akio; Fukuda, Haruyuki; Taniguchi, Shuji; Sakai, Kazuaki

    2000-01-01

    The results of radiation therapy for metastatic spinal tumors were evaluated in terms of pain relief, improvement of neurological impairment, and survival. Between 1986 and 1995, 52 symptomatic patients with metastatic spinal tumors treated with radiation therapy were evaluated. The patients all received irradiation of megavoltage energy. Therapeutic efficacy was evaluated in terms of pain relief and improvement of neurological impairment. Pain relief was observed in 29 (61.7%) of 47 patients with pain. Therapy was effective for 17 (70.8%) of 24 patients without neurological impairment, and efficacy was detected in 12 (52.2%) of 23 patients with neurological impairment. Improvement of neurological symptoms was obtained in seven (25.0%) of 28 patients with neurological impairment. Radiation therapy was effective for pain relief in patients with metastatic spinal tumors. In patients with neurological impairment, less pain relief was observed than in those without impairment. Improvement of neurological impairment was restricted, but radiation therapy was thought to be effective in some cases in the early stage of neurological deterioration. Radiation therapy for metastatic spinal tumors contraindicated for surgery was considered effective for improvement of patients' activities of daily living. (author)

  19. Diagnosis and therapy of spinal tumors

    International Nuclear Information System (INIS)

    Algra, P.R.; Valk, J.; Heimans, J.J.

    1998-01-01

    Many different opinions exist as to the appropriate diagnostic workup and therapy for spinal tumors. With the advent of new imaging techniques and therapeutic regimens, an up-to-date reference work has become an urgent requirement. This book is designed to meet this need, and is the first of its kind to offer an overview of the opinions of internationally renowned specialists in the field. By addressing in detail all of the relevant topics and areas of contention, it should prove of great value in establishing rational imaging and therapeutic protocols for spinal tumors. (orig.)

  20. Spinal cysts. Diagnostic workup and therapy; Spinale Zysten. Diagnostik und Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Simgen, A. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

    2018-02-15

    Spinal cysts can be classified as meningeal, not meningeal, and tumor-associated cysts. Due to the widespread availability of high-resolution computed tomography and magnet resonance imaging, spinal cysts can be detected with high sensitivity these days. Concerning the variety of potential cystic differential diagnoses, a precise classification is difficult and can often only be realized after surgical inspection or histological examination. Spinal cysts are generally incidental findings during a routine diagnostic workup and need no further therapy. Surgical treatment can be necessary if the spinal cyst reaches a certain size and causes neurological symptoms due to the compression of the spinal cord or the nerve root. (orig.) [German] Spinale Zysten koennen in meningeale, nichtmeningeale und tumorassoziierte Zysten eingeteilt werden. Durch die weite Verbreitung von hochaufloesenden Computer- und Magnetresonanztomographen koennen spinale Zysten heutzutage mit einer hohen Sensitivitaet erkannt werden. Eine genaue Klassifikation kann sich unter der Vielzahl der moeglichen zystischen Differenzialdiagnosen schwierig gestalten und ist haeufig nur durch eine chirurgische Inspektion oder die histologische Untersuchung moeglich. Meistens werden spinale Zysten bei der Routinediagnostik als Zufallsbefunde entdeckt und benoetigen keine weitere Therapie. Erreichen sie allerdings eine gewisse Groesse, koennen sie raumfordernd auf das Myelon oder einzelne Nervenwurzeln wirken und somit ausgepraegte neurologische Symptome verursachen. In solchen Faellen ist ein chirurgisches Vorgehen zur Resektion einer spinalen Zyste notwendig. (orig.)

  1. 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.

  2. Impact of Spinal Manipulation on Cortical Drive to Upper and Lower Limb Muscles

    Directory of Open Access Journals (Sweden)

    Heidi Haavik

    2016-12-01

    Full Text Available This study investigates whether spinal manipulation leads to changes in motor control by measuring the recruitment pattern of motor units in both an upper and lower limb muscle and to see whether such changes may at least in part occur at the cortical level by recording movement related cortical potential (MRCP amplitudes. In experiment one, transcranial magnetic stimulation input–output (TMS I/O curves for an upper limb muscle (abductor pollicus brevis; APB were recorded, along with F waves before and after either spinal manipulation or a control intervention for the same subjects on two different days. During two separate days, lower limb TMS I/O curves and MRCPs were recorded from tibialis anterior muscle (TA pre and post spinal manipulation. Dependent measures were compared with repeated measures analysis of variance, with p set at 0.05. Spinal manipulation resulted in a 54.5% ± 93.1% increase in maximum motor evoked potential (MEPmax for APB and a 44.6% ± 69.6% increase in MEPmax for TA. For the MRCP data following spinal manipulation there were significant difference for amplitude of early bereitschafts-potential (EBP, late bereitschafts potential (LBP and also for peak negativity (PN. The results of this study show that spinal manipulation leads to changes in cortical excitability, as measured by significantly larger MEPmax for TMS induced input–output curves for both an upper and lower limb muscle, and with larger amplitudes of MRCP component post manipulation. No changes in spinal measures (i.e., F wave amplitudes or persistence were observed, and no changes were shown following the control condition. These results are consistent with previous findings that have suggested increases in strength following spinal manipulation were due to descending cortical drive and could not be explained by changes at the level of the spinal cord. Spinal manipulation may therefore be indicated for the patients who have lost tonus of their muscle

  3. Does cervical lordosis change after spinal manipulation for non-specific neck pain? A prospective cohort study.

    Science.gov (United States)

    Shilton, Michael; Branney, Jonathan; de Vries, Bas Penning; Breen, Alan C

    2015-01-01

    The association between cervical lordosis (sagittal alignment) and neck pain is controversial. Further, it is unclear whether spinal manipulative therapy can change cervical lordosis. This study aimed to determine whether cervical lordosis changes after a course of spinal manipulation for non-specific neck pain. Posterior tangents of C2 and C6 were drawn on the lateral cervical fluoroscopic images of 29 patients with subacute/chronic non-specific neck pain and 30 healthy volunteers matched for age and gender, recruited August 2011 to April 2013. The resultant angle was measured using 'Image J' digital geometric software. The intra-observer repeatability (measurement error and reliability) and intra-subject repeatability (minimum detectable change (MDC) over 4 weeks) were determined in healthy volunteers. A comparison of cervical lordosis was made between patients and healthy volunteers at baseline. Change in lordosis between baseline and 4-week follow-up was determined in patients receiving spinal manipulation. Intra-observer measurement error for cervical lordosis was acceptable (SEM 3.6°) and reliability was substantial ICC 0.98, 95 % CI 0.962-0991). The intra-subject MDC however, was large (13.5°). There was no significant difference between lordotic angles in patients and healthy volunteers (p = 0.16). The mean cervical lordotic increase over 4 weeks in patients was 2.1° (9.2) which was not significant (p = 0.12). This study found no difference in cervical lordosis (sagittal alignment) between patients with mild non-specific neck pain and matched healthy volunteers. Furthermore, there was no significant change in cervical lordosis in patients after 4 weeks of cervical spinal manipulation.

  4. Peyton's four-step approach for teaching complex spinal manipulation techniques - a prospective randomized trial.

    Science.gov (United States)

    Gradl-Dietsch, Gertraud; Lübke, Cavan; Horst, Klemens; Simon, Melanie; Modabber, Ali; Sönmez, Tolga T; Münker, Ralf; Nebelung, Sven; Knobe, Matthias

    2016-11-03

    The objectives of this prospective randomized trial were to assess the impact of Peyton's four-step approach on the acquisition of complex psychomotor skills and to examine the influence of gender on learning outcomes. We randomly assigned 95 third to fifth year medical students to an intervention group which received instructions according to Peyton (PG) or a control group, which received conventional teaching (CG). Both groups attended four sessions on the principles of manual therapy and specific manipulative and diagnostic techniques for the spine. We assessed differences in theoretical knowledge (multiple choice (MC) exam) and practical skills (Objective Structured Practical Examination (OSPE)) with respect to type of intervention and gender. Participants took a second OSPE 6 months after completion of the course. There were no differences between groups with respect to the MC exam. Students in the PG group scored significantly higher in the OSPE. Gender had no additional impact. Results of the second OSPE showed a significant decline in competency regardless of gender and type of intervention. Peyton's approach is superior to standard instruction for teaching complex spinal manipulation skills regardless of gender. Skills retention was equally low for both techniques.

  5. [History of conservative spinal therapy].

    Science.gov (United States)

    Kladny, B

    2015-12-01

    Hippocrates was the first to intensively describe and document the principles for the treatment of injuries and diseases of the spine. His principles for abrupt treatment of the "hunchback" were followed by physicians even up to the end of the nineteenth century. The non-operative treatment of scoliosis was improved in the beginning of the sixteenth century by the introduction of mechanical devices that started the development of corsets which are still in use in modern scoliosis treatment. Stretching beds were only in temporary use. With the beginning of the nineteenth century gymnastics and physiotherapy became more and more important. Manual therapy was exercised by physicians until the late Middle Ages. After a long period of time in which bonesetters and other laymen performed manual therapy it was professionalized at the end of the nineteenth century again by the introduction of osteopathy and chiropractic. In Germany the development and introduction of manual treatment started relatively late in the twentieth century, predominantly as manual medicine.

  6. The effects of a single session of spinal manipulation on strength and cortical drive in athletes

    DEFF Research Database (Denmark)

    Christiansen, Thomas Lykke; Niazi, Imran Khan; Holt, Kelly

    2018-01-01

    PURPOSE: The primary purpose of this study was to investigate whether a single session of spinal manipulation (SM) increases strength and cortical drive in the lower limb (soleus muscle) of elite Taekwondo athletes. METHODS: Soleus-evoked V-waves, H-reflex and maximum voluntary contraction (MVC) ...

  7. The effect of spinal manipulation on deep experimental muscle pain in healthy volunteers

    DEFF Research Database (Denmark)

    O'Neill, Søren; Ødegaard-Olsen, Øystein; Søvde, Beate

    2015-01-01

    individuals. METHODS AND MATERIALS: Local, para-spinal muscle pain was induced by injection of 0.5 ml sterile, hyper-tonic saline on two separate occasions 1 week apart. Immediately following the injection, treatment was administered as either a) HVLA-manipulation or b) placebo treatment, in a randomized...

  8. Enhancement of in vitro interleukin-2 production in normal subjects following a single spinal manipulative treatment

    Directory of Open Access Journals (Sweden)

    Harris Glen M

    2008-05-01

    Full Text Available Abstract Background Increasing evidence supports somato-visceral effects of manual therapies. We have previously demonstrated that a single spinal manipulative treatment (SMT accompanied by audible release has an inhibitory effect on the production of proinflammatory cytokines in asymptomatic subjects. The purpose of this study is to report on SMT-related changes in the production of the immunoregulatory cytokine interleukin 2 (IL-2 and to investigate whether such changes might differ with respect to the treatment approach related to the presence or absence of an audible release (joint cavitation. Methods Of 76 asymptomatic subjects, 29 received SMT with cavitation (SMT-C, 23 were treated with SMT without cavitation (SMT-NC and 24 comprised the venipuncture control (VC group. The SMT-C and SMT-NC subjects received a single, similar force high velocity low amplitude manipulation, in the upper thoracic spine. However, in SMT-NC subjects, positioning and line of drive were not conducive to cavitation. Blood and serum samples were obtained before and then at 20 and 120 min post-intervention. The production of IL-2 in peripheral blood mononuclear cell cultures was induced by activation for 48 hr with Staphylococcal protein A (SPA and, in parallel preparations, with the combination of phorbol ester (TPA and calcium ionophore. The levels of IL-2 in culture supernatants and serum were assessed by specific immunoassays. Results Compared with VC and their respective baselines, SPA-induced secretion of IL-2 increased significantly in cultures established from both SMT-C and SMT-NC subjects at 20 min post-intervention. At 2 hr post-treatment, significant elevation of IL-2 synthesis was still apparent in preparations from SMT-treated groups though it became somewhat attenuated in SMT-NC subjects. Conversely, IL-2 synthesis induced by TPA and calcium ionophore was unaltered by either type of SMT and was comparable to that in VC group at all time points. No

  9. A narrative review of massage and spinal manipulation in the treatment of low back pain

    Directory of Open Access Journals (Sweden)

    Nurhanisah Sejari

    2014-01-01

    Full Text Available Low back pain (LBP is one of the most common musculoskeletal problems that affect patients′ daily life. Nowadays, treatment of LBP is very challenging due to the recurrent nature of the problem. This narrative review focuses on massage and spinal manipulation on LBP condition. The other issues consist of epidemiology, etiology, symptoms, and rapport between clinician and patient on treatment were explored. Online electronic search in databases (Ovid TM , Scopus, EMBASE and PubMed was performed using key words such as LBP, massage, and spinal manipulation. Textbooks and web page are additional sources that were used for gathering information. Literature reported that high incidence of LBP in agriculture areas which is farmer, in the urban area mainly office worker and industrial area mainly factory operator. LBP frequently occurs among office workers, pregnant, and obesity due to poor body mechanics. Building a successful rapport is a single most important factor in a relationship between clinician and patient. Understanding patient′s perspective in their illness such as belief about cause, treatment approaches, and quality-of-life will help clinician create plans that are more appropriate to patient′s situation and preferences. Patient′s trust is the easing way for the clinician to provide treatments. Based on current evidence, there are arrays of conservative treatments shown to be effective in treating LBP. However, massage and spinal manipulation are the most popular among LBP patients because it contributes good effect in reducing pain intensity. Massage preferred by certain patient such as traditional Malay massage, Thai massage, Tui Na because it provide a relaxation on the body. In addition, spinal manipulation also showed a positive outcome on pain reduction and joint hypomobility. LBP is a common problem, and various methods could be used as a treatment. However, traditional massage is fast gaining popularity even in the

  10. Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series

    Directory of Open Access Journals (Sweden)

    Lawrence Gary

    2004-09-01

    Full Text Available Abstract Background The combination of spinal manipulation and various physiotherapeutic procedures used to correct the curvatures associated with scoliosis have been largely unsuccessful. Typically, the goals of these procedures are often to relax, strengthen, or stretch musculotendinous and/or ligamentous structures. In this study, we investigate the possible benefits of combining spinal manipulation, positional traction, and neuromuscular reeducation in the treatment of idiopathic scoliosis. Methods A total of 22 patient files were selected to participate in the protocol. Of these, 19 met the study criterion required for analysis of treatment benefits. Anteroposterior radiographs were taken of each subject prior to treatment intervention and 4–6 weeks following the intervention. A Cobb angle was drawn and analyzed on each radiograph, so pre and post comparisons could be made. Results After 4–6 weeks of treatment, the treatment group averaged a 17° reduction in their Cobb angle measurements. None of the patients' Cobb angles increased. A total of 3 subjects were dismissed from the study for noncompliance relating to home care instructions, leaving 19 subjects to be evaluated post-intervention. Conclusions The combined use of spinal manipulation and postural therapy appeared to significantly reduce the severity of the Cobb angle in all 19 subjects. These results warrant further testing of this protocol.

  11. Rat models of spinal cord injury: from pathology to potential therapies

    Science.gov (United States)

    2016-01-01

    ABSTRACT A long-standing goal of spinal cord injury research is to develop effective spinal cord repair strategies for the clinic. Rat models of spinal cord injury provide an important mammalian model in which to evaluate treatment strategies and to understand the pathological basis of spinal cord injuries. These models have facilitated the development of robust tests for assessing the recovery of locomotor and sensory functions. Rat models have also allowed us to understand how neuronal circuitry changes following spinal cord injury and how recovery could be promoted by enhancing spontaneous regenerative mechanisms and by counteracting intrinsic inhibitory factors. Rat studies have also revealed possible routes to rescuing circuitry and cells in the acute stage of injury. Spatiotemporal and functional studies in these models highlight the therapeutic potential of manipulating inflammation, scarring and myelination. In addition, potential replacement therapies for spinal cord injury, including grafts and bridges, stem primarily from rat studies. Here, we discuss advantages and disadvantages of rat experimental spinal cord injury models and summarize knowledge gained from these models. We also discuss how an emerging understanding of different forms of injury, their pathology and degree of recovery has inspired numerous treatment strategies, some of which have led to clinical trials. PMID:27736748

  12. A clinical observation of irritable bowel syndrome treated by traditional Chinese spinal orthopedic manipulation.

    Science.gov (United States)

    Xing, Liyang; Qu, Liuxin; Chen, Hong; Gao, Song

    2013-12-01

    To evaluate the clinical effect of Traditional Chinese Spinal Orthopedic Manipulation (TCSOM) in treating Irritable Bowel Syndrome (IBS) in comparison with Pinaverium Bromide Dicetel (PBD), and to assess a possible cause for IBS. 60 cases of IBS patients were randomly divided into two groups: TCSOM and PBD. All patients in the TCSOM group were treated with a 5-time spinal manipulations. The symptoms of pre-treatment and post-treatment were evaluated based on bowel symptom scale (BSS) scores. A symptom improvement rating (SIR) and patient subjective assessment (PSA) were implemented in order to evaluate the effects of the treatments, and to statistically compare the two groups. The symptoms of 23 patients of the TCSOM group disappeared soon after spinal manipulation and 6 cases were significantly improved. The BSS scores in the TCSOM group were significantly lower than those in the PBD group post-treatment. According to the SIR which was based on the BSS, the TCSOM research group included 14 cases with excellent results, 13 cases with good, and 3 cases with poor. Adverse side effects to the treatment were not reported. Based on the BSS, the PBD research group reported 7 cases with excellent results, 8 cases with good and 15 cases with poor. All cases were statistically analyzed, revealing a significant difference (Pinter-vertebral disks and/or vertebra in the thoracic or lumbar region seems to be a contributing factor in the symptoms of irritable bowel syndrome. Thumb pressing manipulation on jiaji points in the thoracic and/or lumbar region can correct the displacement of inter-vertebral disks and/or vertebra, resolving the stimuli caused by pressure exerted on the nerves and vessels around the spine. So it is an effective treatment for IBS. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Scoliosis treatment using spinal manipulation and the Pettibon Weighting System™: a summary of 3 atypical presentations

    Directory of Open Access Journals (Sweden)

    Joy Timothy

    2006-01-01

    Full Text Available Abstract Background Given the relative lack of treatment options for mild to moderate scoliosis, when the Cobb angle measurements fall below the 25–30° range, conservative manual therapies for scoliosis treatment have been increasingly investigated in recent years. In this case series, we present 3 specific cases of scoliosis. Case presentation Patient presentation, examination, intervention and outcomes are detailed for each case. The types of scoliosis presented here are left thoracic, idiopathic scoliosis after Harrington rod instrumentation, and a left thoracic scoliosis secondary to Scheuermann's Kyphosis. Each case carries its own clinical significance, in relation to clinical presentation. The first patient presented for chiropractic treatment with a 35° thoracic dextroscoliosis 18 years following Harrington Rod instrumentation and fusion. The second patient presented with a 22° thoracic levoscoliosis and concomitant Scheuermann's Disease. Finally, the third case summarizes the treatment of a patient with a primary 37° idiopathic thoracic levoscoliosis. Each patient was treated with a novel active rehabilitation program for varying lengths of time, including spinal manipulation and a patented external head and body weighting system. Following a course of treatment, consisting of clinic and home care treatments, post-treatment radiographs and examinations were conducted. Improvement in symptoms and daily function was obtained in all 3 cases. Concerning Cobb angle measurements, there was an apparent reduction in Cobb angle of 13°, 8°, and 16° over a maximum of 12 weeks of treatment. Conclusion Although mild to moderate reductions in Cobb angle measurements were achieved in these cases, these improvements may not be related to the symptomatic and functional improvements. The lack of a control also includes the possibility of a placebo effect. However, this study adds to the growing body of literature investigating methods by which

  14. Increased multiaxial lumbar motion responses during multiple-impulse mechanical force manually assisted spinal manipulation

    Directory of Open Access Journals (Sweden)

    Gunzburg Robert

    2006-04-01

    Full Text Available Abstract Background Spinal manipulation has been found to create demonstrable segmental and intersegmental spinal motions thought to be biomechanically related to its mechanisms. In the case of impulsive-type instrument device comparisons, significant differences in the force-time characteristics and concomitant motion responses of spinal manipulative instruments have been reported, but studies investigating the response to multiple thrusts (multiple impulse trains have not been conducted. The purpose of this study was to determine multi-axial segmental and intersegmental motion responses of ovine lumbar vertebrae to single impulse and multiple impulse spinal manipulative thrusts (SMTs. Methods Fifteen adolescent Merino sheep were examined. Tri-axial accelerometers were attached to intraosseous pins rigidly fixed to the L1 and L2 lumbar spinous processes under fluoroscopic guidance while the animals were anesthetized. A hand-held electromechanical chiropractic adjusting instrument (Impulse was used to apply single and repeated force impulses (13 total over a 2.5 second time interval at three different force settings (low, medium, and high along the posteroanterior axis of the T12 spinous process. Axial (AX, posteroanterior (PA, and medial-lateral (ML acceleration responses in adjacent segments (L1, L2 were recorded at a rate of 5000 samples per second. Peak-peak segmental accelerations (L1, L2 and intersegmental acceleration transfer (L1–L2 for each axis and each force setting were computed from the acceleration-time recordings. The initial acceleration response for a single thrust and the maximum acceleration response observed during the 12 multiple impulse trains were compared using a paired observations t-test (POTT, alpha = .05. Results Segmental and intersegmental acceleration responses mirrored the peak force magnitude produced by the Impulse Adjusting Instrument. Accelerations were greatest for AX and PA measurement axes. Compared to

  15. 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.

  16. Does inter-vertebral range of motion increase after spinal manipulation? A prospective cohort study.

    Science.gov (United States)

    Branney, Jonathan; Breen, Alan C

    2014-01-01

    Spinal manipulation for nonspecific neck pain is thought to work in part by improving inter-vertebral range of motion (IV-RoM), but it is difficult to measure this or determine whether it is related to clinical outcomes. This study undertook to determine whether cervical spine flexion and extension IV-RoM increases after a course of spinal manipulation, to explore relationships between any IV-RoM increases and clinical outcomes and to compare palpation with objective measurement in the detection of hypo-mobile segments. Thirty patients with nonspecific neck pain and 30 healthy controls matched for age and gender received quantitative fluoroscopy (QF) screenings to measure flexion and extension IV-RoM (C1-C6) at baseline and 4-week follow-up between September 2012-13. Patients received up to 12 neck manipulations and completed NRS, NDI and Euroqol 5D-5L at baseline, plus PGIC and satisfaction questionnaires at follow-up. IV-RoM accuracy, repeatability and hypo-mobility cut-offs were determined. Minimal detectable changes (MDC) over 4 weeks were calculated from controls. Patients and control IV-RoMs were compared at baseline as well as changes in patients over 4 weeks. Correlations between outcomes and the number of manipulations received and the agreement (Kappa) between palpated and QF-detected of hypo-mobile segments were calculated. QF had high accuracy (worst RMS error 0.5o) and repeatability (highest SEM 1.1o, lowest ICC 0.90) for IV-RoM measurement. Hypo-mobility cut offs ranged from 0.8o to 3.5o. No outcome was significantly correlated with increased IV-RoM above MDC and there was no significant difference between the number of hypo-mobile segments in patients and controls at baseline or significant increases in IV-RoMs in patients. However, there was a modest and significant correlation between the number of manipulations received and the number of levels and directions whose IV-RoM increased beyond MDC (Rho=0.39, p=0.043). There was also no agreement

  17. Osteopathic manipulative treatment is effective on pain control associated to spinal cord injury.

    Science.gov (United States)

    Arienti, C; Daccò, S; Piccolo, I; Redaelli, T

    2011-04-01

    This study was designed as an experimental study (trial). To verify the effects of the association between conventional pharmacological treatment and osteopathic manipulative treatment (OMT) for chronic pain management in spinal cord injury (SCI). This study was carried out at Spinal Unit, Ospedale Niguarda Ca' Granda, Milan, Italy. Istituto Superiore di Osteopatia, Milan, Italy. We enrolled 47 patients with SCI, 26 with pain of both nociceptive and neuropathic origin, and 21 with pure neuropathic pain. In all, 33 patients had a complete spinal cord lesion (ASIA level A) and 14 had incomplete lesion (ASIA level B, C and D). The patients were subdivided in a pharmacological group (Ph), a pharmacological osteopathic (PhO) group and a osteopathic (Os) group. The verbal numeric scale (VNS) was used at various time intervals to evaluate treatment outcomes. Ph patients reached a 24% improvement in their pain perception, assessed by the VNS scale after 3 weeks of treatment, whereas Os patients reached a 16% improvement in their pain perception for the same weeks. Both treatments per se failed to induce further improvements at later time points. In contrast, the combination of the two approaches yielded a significantly better pain relief both in patients with nociceptive or pure neuropathic pain in the PhO group. Our results suggest the OMT is a feasible approach in patients in whom available drugs cannot be used. Moreover, a benefit can be expected by the association of OMT in patients treated according to existing pharmacological protocols.

  18. Feasibility of boron neutron capture therapy for malignant spinal tumors

    International Nuclear Information System (INIS)

    Nakai, Kei; Kumada, Hiroaki; Yamamoto, Tetsuya; Tsurubuchi, Takao; Zaboronok, Alexander; Matsumura, Akira

    2009-01-01

    Treatment of malignant spinal cord tumors is currently ineffective. The characteristics of the spine are its seriality, small volume, and vulnerability: severe QOL impairment can be brought about by small neuronal damage. The present study aimed to investigate the feasibility of BNCT as a tumor-selective charged particle therapy for spinal cord tumors from the viewpoint of protecting the normal spine. A previous report suggested the tolerance dose of the spinal cord was 13.8 Gy-Eq for radiation myelopathy; a dose as high as 11 Gy-Eq demonstrated no spinal cord damage in an experimental animal model. We calculated the tumor dose and the normal spinal cord dose on a virtual model of a spinal cord tumor patient with a JAEA computational dosimetry system (JCDS) treatment planning system. The present study made use of boronophenylalanine (BPA). In these calculations, conditions were set as follows: tumor/normal (T/N) ratio of 3.5, blood boron concentration of 12 ppm, tumor boron concentration of 42 ppm, and relative biological effectiveness (RBE) values for tumor and normal spinal cord of 3.8 and 1.35, respectively. We examined how to optimize neutron irradiation by changing the beam direction and number. In our theoretical example, simple opposed two-field irradiation achieved 28.0 Gy-Eq as a minimum tumor dose and 7.3 Gy-Eq as a maximum normal spinal dose. The BNCT for the spinal cord tumor was therefore feasible when a sufficient T/N ratio could be achieved. The use of F-BPA PET imaging for spinal tumor patients is supported by this study.

  19. Peyton’s four-step approach for teaching complex spinal manipulation techniques – a prospective randomized trial

    Directory of Open Access Journals (Sweden)

    Gertraud Gradl-Dietsch

    2016-11-01

    Full Text Available Abstract Background The objectives of this prospective randomized trial were to assess the impact of Peyton’s four-step approach on the acquisition of complex psychomotor skills and to examine the influence of gender on learning outcomes. Methods We randomly assigned 95 third to fifth year medical students to an intervention group which received instructions according to Peyton (PG or a control group, which received conventional teaching (CG. Both groups attended four sessions on the principles of manual therapy and specific manipulative and diagnostic techniques for the spine. We assessed differences in theoretical knowledge (multiple choice (MC exam and practical skills (Objective Structured Practical Examination (OSPE with respect to type of intervention and gender. Participants took a second OSPE 6 months after completion of the course. Results There were no differences between groups with respect to the MC exam. Students in the PG group scored significantly higher in the OSPE. Gender had no additional impact. Results of the second OSPE showed a significant decline in competency regardless of gender and type of intervention. Conclusions Peyton’s approach is superior to standard instruction for teaching complex spinal manipulation skills regardless of gender. Skills retention was equally low for both techniques.

  20. Radiation therapy for primary spinal cord tumors in adults

    International Nuclear Information System (INIS)

    Jeremic, B.; Grujicic, D.; Jovanovic, D.; Djuric, L.; Mijatovic, L.

    1990-01-01

    This paper evaluates the role of radiation therapy in management of primary spinal cord tumors in adults. Records of 21 patients with primary spinal cord tumors treated with radiation therapy after surgery were retrospectively reviewed. Histologic examination showed two diffuse and 10 localized ependymomas, six low-grade gliomas, and three malignant gliomas. Surgery consisted of gross tumor resection in six patients, subtotal resection in three patients, and biopsy in 12 patients. Three patients also received chemotherapy. Radiation dose range from 45 to 55 Cy

  1. Clinical effect of traditional Chinese spinal orthopedic manipulation in treatment of Functional Abdominal Pain Syndrome.

    Science.gov (United States)

    Xing, Liyang; Qu, Liuxin; Chen, Hong; Gao, Song

    2017-06-01

    To evaluate the clinical effect of Traditional Chinese Spinal Orthopedic Manipulation (TCSOM) in treating Functional Abdominal Pain Syndrome (FAPS) in comparison with Pinaverium Bromide (Dicetel, PBD), and to assess a possible cause for FAPS. 60 cases of FAPS patients were randomly assigned to the TCSOM group and PBD group according to the random number table method. The TCSOM group was treated with thumb pressing manipulation, every other day in the first week, and once every three days in the second week, for 5 times treatments. Patients in the PBD group were instructed to take 50mg 3 times a day, consistently for 2 weeks. The symptoms of pre-treatment and post-treatment were assessed on a visual analog scale (VAS) pain score. A symptom improvement rating (SIR) was implemented in order to evaluate the effects of the treatments, and to statistically compare the two groups. The symptoms of 21 patients of the TCSOM group were resolved soon after the first spinal manipulation treatment and 4 cases were significantly improved. The VAS pain scores in the TCSOM group were significantly lower than those in the PBD group after 2 weeks treatment. According to the SIR based on VAS, the TCSOM research group included 20 cases with excellent results, 8 cases with good, and 2 cases with poor. There were no side effects in the TCSOM group after treatment. Based on VAS, the PBD research group reported 6 cases with excellent results, 8 cases with good and 16 cases with poor. All cases were statistically analyzed, revealing a significant difference (Pabdominal pain indicating that it is an effective treatment for FAPS. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  2. Adolescents' perceptions of music therapy following spinal fusion surgery.

    Science.gov (United States)

    Kleiber, Charmaine; Adamek, Mary S

    2013-02-01

    To explore adolescents' memories about music therapy after spinal fusion surgery and their recommendations for future patients. Spinal fusion for adolescent idiopathic scoliosis is one of the most painful surgeries performed. Music therapy is shown to decrease postoperative pain in children after minor surgery. In preparation for developing a preoperative information program, we interviewed adolescents who had spinal fusion and postoperative music therapy to find out what they remembered and what they recommended for future patients. Eight adolescents who had spinal fusion for adolescent idiopathic scoliosis were interviewed about their experiences. For this qualitative study, the investigators independently used thematic analysis techniques to formulate interpretive themes. Together they discussed their ideas and assigned overall meanings to the information. The eight participants were 13-17 years of age and had surgery between 2-24 months previously. The overarching themes identified from the interviews were relaxation and pain perception, choice and control, therapist interaction and preoperative information. Participants stated that music therapy helped with mental relaxation and distraction from pain. It was important to be able to choose the type of music for the therapy and to use self-control to focus on the positive. Their recommendation was that future patients should be provided with information preoperatively about music therapy and pain management. Participants recommended a combination of auditory and visual information, especially the experiences of previous patients who had spinal fusion and music therapy. Music provided live at the bedside by a music therapist was remembered vividly and positively by most of the participants. The presence of a music therapist providing patient-selected music at the bedside is important. Methods to introduce adolescents to music therapy and how to use music for relaxation should be developed and tested. © 2012

  3. [Stereotactic body radiation therapy for spinal metastases].

    Science.gov (United States)

    Pasquier, D; Martinage, G; Mirabel, X; Lacornerie, T; Makhloufi, S; Faivre, J-C; Thureau, S; Lartigau, É

    2016-10-01

    After the liver and lungs, bones are the third most common sites of cancer metastasis. Palliative radiotherapy for secondary bone tumours helps relieve pain, improve the quality of life and reduce the risk of fractures. Stereotactic body radiotherapy can deliver high radiation doses with very tight margins, which has significant advantages when treating tumours close to the spinal cord. Strict quality control is essential as dose gradient at the edge of the spinal cord is important. Optimal schedule is not defined. A range of dose-fractionation schedules have been used. Pain relief and local control are seen in over 80%. Toxicity rates are low, although vertebral fracture may occur. Ongoing prospective studies will help clarify its role in the management of oligometastatic patients. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  4. Stereotactic Body Radiation Therapy in Spinal Metastases

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    Ahmed, Kamran A. [Mayo Medical School, College of Medicine, Mayo Clinic, Rochester, MN (United States); Stauder, Michael C.; Miller, Robert C.; Bauer, Heather J. [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Rose, Peter S. [Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (United States); Olivier, Kenneth R. [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Brown, Paul D. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Brinkmann, Debra H. [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Laack, Nadia N., E-mail: laack.nadia@mayo.edu [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States)

    2012-04-01

    Purpose: Based on reports of safety and efficacy, stereotactic body radiotherapy (SBRT) for treatment of malignant spinal tumors was initiated at our institution. We report prospective results of this population at Mayo Clinic. Materials and Methods: Between April 2008 and December 2010, 85 lesions in 66 patients were treated with SBRT for spinal metastases. Twenty-two lesions (25.8%) were treated for recurrence after prior radiotherapy (RT). The mean age of patients was 56.8 {+-} 13.4 years. Patients were treated to a median dose of 24 Gy (range, 10-40 Gy) in a median of three fractions (range, 1-5). Radiation was delivered with intensity-modulated radiotherapy (IMRT) and prescribed to cover 80% of the planning target volume (PTV) with organs at risk such as the spinal cord taking priority over PTV coverage. Results: Tumor sites included 48, 22, 12, and 3 in the thoracic, lumbar, cervical, and sacral spine, respectively. The mean actuarial survival at 12 months was 52.2%. A total of 7 patients had both local and marginal failure, 1 patient experienced marginal but not local failure, and 1 patient had local failure only. Actuarial local control at 1 year was 83.3% and 91.2% in patients with and without prior RT. The median dose delivered to patients who experienced local/marginal failure was 24 Gy (range, 18-30 Gy) in a median of three fractions (range, 1-5). No cases of Grade 4 toxicity were reported. In 1 of 2 patients experiencing Grade 3 toxicity, SBRT was given after previous radiation. Conclusion: The results indicate SBRT to be an effective measure to achieve local control in spinal metastases. Toxicity of treatment was rare, including those previously irradiated. Our results appear comparable to previous reports analyzing spine SBRT. Further research is needed to determine optimum dose and fractionation to further improve local control and prevent toxicity.

  5. Stereotactic Body Radiation Therapy in Spinal Metastases

    International Nuclear Information System (INIS)

    Ahmed, Kamran A.; Stauder, Michael C.; Miller, Robert C.; Bauer, Heather J.; Rose, Peter S.; Olivier, Kenneth R.; Brown, Paul D.; Brinkmann, Debra H.; Laack, Nadia N.

    2012-01-01

    Purpose: Based on reports of safety and efficacy, stereotactic body radiotherapy (SBRT) for treatment of malignant spinal tumors was initiated at our institution. We report prospective results of this population at Mayo Clinic. Materials and Methods: Between April 2008 and December 2010, 85 lesions in 66 patients were treated with SBRT for spinal metastases. Twenty-two lesions (25.8%) were treated for recurrence after prior radiotherapy (RT). The mean age of patients was 56.8 ± 13.4 years. Patients were treated to a median dose of 24 Gy (range, 10–40 Gy) in a median of three fractions (range, 1–5). Radiation was delivered with intensity-modulated radiotherapy (IMRT) and prescribed to cover 80% of the planning target volume (PTV) with organs at risk such as the spinal cord taking priority over PTV coverage. Results: Tumor sites included 48, 22, 12, and 3 in the thoracic, lumbar, cervical, and sacral spine, respectively. The mean actuarial survival at 12 months was 52.2%. A total of 7 patients had both local and marginal failure, 1 patient experienced marginal but not local failure, and 1 patient had local failure only. Actuarial local control at 1 year was 83.3% and 91.2% in patients with and without prior RT. The median dose delivered to patients who experienced local/marginal failure was 24 Gy (range, 18–30 Gy) in a median of three fractions (range, 1–5). No cases of Grade 4 toxicity were reported. In 1 of 2 patients experiencing Grade 3 toxicity, SBRT was given after previous radiation. Conclusion: The results indicate SBRT to be an effective measure to achieve local control in spinal metastases. Toxicity of treatment was rare, including those previously irradiated. Our results appear comparable to previous reports analyzing spine SBRT. Further research is needed to determine optimum dose and fractionation to further improve local control and prevent toxicity.

  6. Cellular therapy after spinal cord injury using neural progenitor cells

    NARCIS (Netherlands)

    Vroemen, Maurice

    2006-01-01

    In this thesis, the possibilities and limitations of cell-based therapies after spinal cord injury are explored. Particularly, the potential of adult derived neural progenitor cell (NPC) grafts to function as a permissive substrate for axonal regeneration was investigated. It was found that syngenic

  7. Inadvertent destruction of the spinal cord by radiation therapy

    International Nuclear Information System (INIS)

    Bhavilai, D.

    1974-01-01

    A case of radiation myelopathy following cobalt therapy of a carcinoma of the esophagus is presented. A permanent quadriplegia resulted. Radiation myelopathy can result from treatment with x-rays or radioactive cobalt regardless of whether the condition being treated involves the spinal cord. No effective treatment is known. Prevention requires keeping the radiation at low level

  8. A pilot randomized controlled trial comparing the efficacy of exercise, spinal manipulation, and neuro emotional technique for the treatment of pregnancy-related low back pain

    Directory of Open Access Journals (Sweden)

    Peterson Caroline D

    2012-06-01

    Full Text Available Abstract Background This pilot randomized controlled trial evaluated the feasibility of conducting a full scale study and compared the efficacy of exercise, spinal manipulation, and a mind-body therapy called Neuro Emotional Technique for the treatment of pregnancy-related low back pain, a common morbidity of pregnancy. Methods Healthy pregnant women with low back pain of insidious onset were eligible to enroll in the study at any point in their pregnancy. Once enrolled, they remained in the study until they had their babies. Women were randomly allocated into one of three treatment groups using opaque envelopes. The treatment schedule paralleled the prenatal care schedule and women received individualized intervention. Our null hypothesis was that spinal manipulation and Neuro Emotional Technique would perform no better than exercise in enhancing function and decreasing pain. Our primary outcome measure was the Roland Morris Disability Questionnaire and our secondary outcome measure was the Numeric Pain Rating Scale. Intention to treat analysis was conducted. For the primary analysis, regression was conducted to compare groups on the outcome measure scores. In a secondary responder analysis, difference in proportions of participants in attaining 30% and 50% improvement were calculated. Feasibility factors for conducting a future larger trial were also evaluated such as recruitment, compliance to study protocols, cost, and adverse events. Results Fifty-seven participants were randomized into the exercise (n = 22, spinal manipulation (n = 15, and Neuro Emotional Technique (n = 20 treatment arms. At least 50% of participants in each treatment group experienced clinically meaningful improvement in symptoms for the Roland Morris Disability Questionnaire. At least 50% of the exercise and spinal manipulation participants also experienced clinically meaningful improvement for the Numeric Pain Rating Scale. There were no clinically

  9. Molecular Imaging in Stem Cell Therapy for Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Fahuan Song

    2014-01-01

    Full Text Available Spinal cord injury (SCI is a serious disease of the center nervous system (CNS. It is a devastating injury with sudden loss of motor, sensory, and autonomic function distal to the level of trauma and produces great personal and societal costs. Currently, there are no remarkable effective therapies for the treatment of SCI. Compared to traditional treatment methods, stem cell transplantation therapy holds potential for repair and functional plasticity after SCI. However, the mechanism of stem cell therapy for SCI remains largely unknown and obscure partly due to the lack of efficient stem cell trafficking methods. Molecular imaging technology including positron emission tomography (PET, magnetic resonance imaging (MRI, optical imaging (i.e., bioluminescence imaging (BLI gives the hope to complete the knowledge concerning basic stem cell biology survival, migration, differentiation, and integration in real time when transplanted into damaged spinal cord. In this paper, we mainly review the molecular imaging technology in stem cell therapy for SCI.

  10. Spinal manipulation under anesthesia: a narrative review of the literature and commentary

    Science.gov (United States)

    2013-01-01

    As exhibited throughout the medical literature over many decades, there is a lack of uniformity in the manner in which spine pain patients have historically qualified for and received manipulation under anesthesia (MUA). Also, for different professions that treat the same types of spinal conditions via the same means, fundamental MUA decision points vary within the published protocols of different professional associations. The more recent chiropractic literature communicates that the evidence to support the efficacy of MUA of the spine remains largely anecdotal. In addition, it has been reported that the types of spinal conditions most suitable for MUA are without clear-cut consensus, with various indications for MUA of the low back resting wholly upon the opinions and experiences of MUA practitioners. This article will provide a narrative review of the MUA literature, followed by a commentary about the current lack of high quality research evidence, the anecdotal and consensus basis of existing clinical protocols, as well as related professional, ethical and legal concerns for the chiropractic practitioner. The limitations of the current medical literature related to MUA via conscious/deep sedation need to be recognized and used as a guide to clinical experience when giving consideration to this procedure. More research, in the form of controlled clinical trials, must be undertaken if this procedure is to remain a potential treatment option for chronic spine pain patients in the chiropractic clinical practice. PMID:23672974

  11. Compression fractures in patients undergoing spinal manipulative therapy

    NARCIS (Netherlands)

    Haldeman, S.; Rubinstein, S M

    Increasing numbers of elderly patients are currently seeking chiropractic care. One condition commonly seen in the elderly is osteoporosis of the spine, which carries with it the risk of compression fractures. We present four cases in which patients were noted to have compression fractures following

  12. A structured review of spinal stiffness as a kinesiological outcome of manipulation: its measurement and utility in diagnosis, prognosis and treatment decision-making.

    Science.gov (United States)

    Snodgrass, Suzanne J; Haskins, Robin; Rivett, Darren A

    2012-10-01

    To review and discuss the methods used for measuring spinal stiffness and factors associated with stiffness, how stiffness is used in diagnosis, prognosis, and treatment decision-making and the effects of manipulative techniques on stiffness. A systematic search of MEDLINE, EMBASE, CINAHL, AMED and ICL databases was conducted. Included studies addressed one of four constructs related to stiffness: measurement, diagnosis, prognosis and/or treatment decision-making, and the effects of manipulation on stiffness. Spinal stiffness was defined as the relationship between force and displacement. One hundred and four studies are discussed in this review, with the majority of studies focused on the measurement of stiffness, most often in asymptomatic persons. Eight studies investigated spinal stiffness in diagnosis, providing limited evidence that practitioner-judged stiffness is associated with radiographic findings of sagittal rotational mobility. Fifteen studies investigated spinal stiffness in prognosis or treatment decision-making, providing limited evidence that spinal stiffness is unlikely to independently predict patient outcomes, though stiffness may influence a practitioner's application of non-thrust manipulative techniques. Nine studies investigating the effects of manipulative techniques on spinal stiffness provide very limited evidence that there is no change in spinal stiffness following thrust or non-thrust manipulation in asymptomatic individuals and non-thrust techniques in symptomatic persons, with only one study supporting an immediate, but not sustained, stiffness decrease following thrust manipulation in symptomatic individuals. The existing limited evidence does not support an association between spinal stiffness and manipulative treatment outcomes. There is a need for additional research investigating the effects of manipulation on spinal stiffness in persons with spinal pain. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Effect of Spinal Manipulation of Upper Cervical Vertebrae on Blood Pressure: Results of a Pilot Sham-Controlled Trial.

    Science.gov (United States)

    Goertz, Christine M; Salsbury, Stacie A; Vining, Robert D; Long, Cynthia R; Pohlman, Katherine A; Weeks, William B; Lamas, Gervasio A

    2016-06-01

    The purpose of this pilot sham-controlled clinical trial was to estimate the treatment effect and safety of toggle recoil spinal manipulation for blood pressure management. Fifty-one participants with prehypertension or stage 1 hypertension (systolic blood pressure ranging from 135 to 159 mm Hg or diastolic blood pressure ranging from 85 to 99 mm Hg) were allocated by an adaptive design to 2 treatments: toggle recoil spinal manipulation or a sham procedure. Participants were seen by a doctor of chiropractic twice weekly for 6 weeks and remained on their antihypertensive medications, as prescribed, throughout the trial. Blood pressure was assessed at baseline and after study visits 1, 6 (week 3), and 12 (week 6), with the primary end point at week 6. Analysis of covariance was used to compare mean blood pressure changes from baseline between groups at each end point, controlling for sex, age, body mass index, and baseline blood pressure. Adjusted mean change from baseline to week 6 was greater in the sham group (systolic, -4.2 mm Hg; diastolic, -1.6 mm Hg) than in the spinal manipulation group (systolic, 0.6 mm Hg; diastolic, 0.7 mm Hg), but the difference was not statistically significant. No serious and few adverse events were noted. Six weeks of toggle recoil spinal manipulation did not lower systolic or diastolic blood pressure when compared with a sham procedure. No serious adverse events from either treatment were reported. Our results do not support a larger clinical trial. Further research to understand the potential mechanisms of action involving upper cervical manipulation on blood pressure is warranted before additional clinical investigations are conducted. Copyright © 2016. Published by Elsevier Inc.

  14. Effects of spinal manipulation and myofascial techniques on heart rate variability: A systematic review.

    Science.gov (United States)

    Amoroso Borges, Bruno Luis; Bortolazzo, Gustavo Luiz; Neto, Hugo Pasin

    2018-01-01

    The analysis of heart rate variability is important to the investigation of stimuli from the autonomic nervous system. Osteopathy is a form of treatment that can influence this system in healthy individuals as well as those with a disorder or disease. The aim of the present study was to perform a systematic review of the literature regarding the effect of spinal manipulation and myofascial techniques on heart rate variability. Searches were performed of the Pubmed, Scielo, Lilacs, PEDro, Ibesco, Cochrane and Scopus databases for relevant studies. The PEDro scale was used to assess the methodological quality of each study selected. A total of 505 articles were retrieved during the initial search. After an analysis of the abstracts, nine studies were selected for the present review. Based on the findings, osteopathy exerts an influence on the autonomic nervous system depending on the stimulation site and type. A greater parasympathetic response was found when stimulation was performed in the cervical and lumbar regions, whereas a greater sympathetic response was found when stimulation was performed in the thoracic region. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Advanced Restoration Therapies in Spinal Cord Injury

    Science.gov (United States)

    2016-05-01

    improve functional outcome post-SCI. SCI was induced at segment T9 in adult rats . The sensory and motor functions were evaluated in the weeks following...the injury. 2) Specific objectives: We tested the outcome of TMS therapy on sensory and motor functions in three groups: SCI rats that received TMS...acute- TMS) have shown greater sensory responses in primary somatosensory cortex of HL representation compared to rats that did not receive any TMS

  16. Chiropractic manipulative therapy of the thoracic spine in combination with stretch and strengthening exercises, in improving postural kyphosis in woman

    Directory of Open Access Journals (Sweden)

    Kim Castello Branco

    2016-12-01

    Conclusion: The study showed that all three treatment protocols for Groups 1, 2, and 3 were effective. However, Group 1 had not shown a great improvement in their postural kyphosis, Group 3 had shown a relatively good improvement in their posture, while Group 2 had shown the best results with regards to improvement of the participants' posture. Therefore, in conclusion, Groups 2 and 3 treatment protocols can be used effectively to treat postural kyphosis but Group 2's treatment protocol, consisting of chiropractic spinal manipulative therapy to the thoracic spine in combination with stretch and strengthening exercises, will yield the best results.

  17. Manipulators

    International Nuclear Information System (INIS)

    Wilcock, P.D.

    1984-01-01

    The patent concerns a manipulator, which enables operations to be carried out remotely from the operator. The device is suitable for use in handling of radioactive materials and other hazardous liquids or gases. The specifications are given, and the movements of the manipulator arm described. (U.K.)

  18. A model for teaching and learning spinal thrust manipulation and its effect on participant confidence in technique performance.

    Science.gov (United States)

    Wise, Christopher H; Schenk, Ronald J; Lattanzi, Jill Black

    2016-07-01

    Despite emerging evidence to support the use of high velocity thrust manipulation in the management of lumbar spinal conditions, utilization of thrust manipulation among clinicians remains relatively low. One reason for the underutilization of these procedures may be related to disparity in training in the performance of these techniques at the professional and post professional levels. To assess the effect of using a new model of active learning on participant confidence in the performance of spinal thrust manipulation and the implications for its use in the professional and post-professional training of physical therapists. A cohort of 15 DPT students in their final semester of entry-level professional training participated in an active training session emphasizing a sequential partial task practice (SPTP) strategy in which participants engaged in partial task practice over several repetitions with different partners. Participants' level of confidence in the performance of these techniques was determined through comparison of pre- and post-training session surveys and a post-session open-ended interview. The increase in scores across all items of the individual pre- and post-session surveys suggests that this model was effective in changing overall participant perception regarding the effectiveness and safety of these techniques and in increasing student confidence in their performance. Interviews revealed that participants greatly preferred the SPTP strategy, which enhanced their confidence in technique performance. Results indicate that this new model of psychomotor training may be effective at improving confidence in the performance of spinal thrust manipulation and, subsequently, may be useful for encouraging the future use of these techniques in the care of individuals with impairments of the spine. Inasmuch, this method of instruction may be useful for training of physical therapists at both the professional and post-professional levels.

  19. Effect of cervical vs. thoracic spinal manipulation on peripheral neural features and grip strength in subjects with chronic mechanical neck pain: a randomized controlled trial.

    Science.gov (United States)

    Bautista-Aguirre, Francisco; Oliva-Pascual-Vaca, Ángel; Heredia-Rizo, Alberto M; Boscá-Gandía, Juan J; Ricard, François; Rodriguez-Blanco, Cleofás

    2017-06-01

    Cervical and thoracic spinal manipulative therapy has shown positive impact for relief of pain and improve function in non-specific mechanical neck pain. Several attempts have been made to compare their effectiveness although previous studies lacked a control group, assessed acute neck pain or combined thrust and non-thrust techniques. To compare the immediate effects of cervical and thoracic spinal thrust manipulations on mechanosensitivity of upper limb nerve trunks and grip strength in patients with chronic non-specific mechanical neck pain. Randomized, single-blinded, controlled clinical trial. Private physiotherapy clinical consultancy. Eighty-eight subjects (32.09±6.05 years; 72.7% females) suffering neck pain (grades I or II) of at least 12 weeks of duration. Participants were distributed into three groups: 1) cervical group (N.=28); 2) thoracic group (N.=30); and 3) control group (N.=30). One treatment session consisting of applying a high-velocity low-amplitude spinal thrust technique over the lower cervical spine (C7) or the upper thoracic spine (T3) was performed, while the control group received a sham-manual contact. Measurements were taken at baseline and after intervention of the pressure pain threshold over the median, ulnar and radial nerves. Secondary measures included assessing free-pain grip strength with a hydraulic dynamometer. No statistically significant differences were observed when comparing between-groups in any of the outcome measures (P>0.05). Those who received thrust techniques, regardless of the manipulated area, reported an immediate increase in mechanosensitivity over the radial (both sides) and left ulnar nerve trunks (Ppain perception over the radial nerve also improved (P≤0.025). Low-cervical and upper-thoracic thrust manipulation is no more effective than placebo to induce immediate changes on mechanosensitivity of upper limb nerve trunks and grip strength in patients with chronic non-specific mechanical neck pain. A single

  20. Induced Pluripotent Stem Cell Therapies for Cervical Spinal Cord Injury

    Science.gov (United States)

    Doulames, Vanessa M.; Plant, Giles W.

    2016-01-01

    Cervical-level injuries account for the majority of presented spinal cord injuries (SCIs) to date. Despite the increase in survival rates due to emergency medicine improvements, overall quality of life remains poor, with patients facing variable deficits in respiratory and motor function. Therapies aiming to ameliorate symptoms and restore function, even partially, are urgently needed. Current therapeutic avenues in SCI seek to increase regenerative capacities through trophic and immunomodulatory factors, provide scaffolding to bridge the lesion site and promote regeneration of native axons, and to replace SCI-lost neurons and glia via intraspinal transplantation. Induced pluripotent stem cells (iPSCs) are a clinically viable means to accomplish this; they have no major ethical barriers, sources can be patient-matched and collected using non-invasive methods. In addition, the patient’s own cells can be used to establish a starter population capable of producing multiple cell types. To date, there is only a limited pool of research examining iPSC-derived transplants in SCI—even less research that is specific to cervical injury. The purpose of the review herein is to explore both preclinical and clinical recent advances in iPSC therapies with a detailed focus on cervical spinal cord injury. PMID:27070598

  1. Spinal interleukin-10 therapy to treat peripheral neuropathic pain.

    Science.gov (United States)

    Milligan, Erin D; Penzkover, Kathryn R; Soderquist, Ryan G; Mahoney, Melissa J

    2012-01-01

      Current research indicates that chronic peripheral neuropathic pain includes a role for glia and the actions of proinflammatory factors. This review briefly discusses the glial and cytokine responses that occur following peripheral nerve damage in support of utilizing anti-inflammatory cytokine interleukin-10 (IL-10) therapy to suppress chronic peripheral neuropathic pain. SPINAL NONVIRAL INTERLEUKIN-10 GENE THERAPY:  IL-10 is one of the most powerful endogenous counter-regulators of proinflammatory cytokine function that acts in the nervous system. Subarachnoid (intrathecal) spinal injection of the gene encoding IL-10 delivered by nonviral vectors has several advantages over virally mediated gene transfer methods and leads to profound pain relief in several animal models. NONVIRAL GENE DELIVERY:  Lastly, data are reviewed that nonviral deoxyribonucleic acid (DNA) encapsulated by a biologically safe copolymer, poly(lactic-co-glycolic) acid (PLGA), thought to protect DNA, leads to significantly improved therapeutic gene transfer in animal models, which additionally and significantly extends pain relief.   The impact of these early studies exploring anti-inflammatory genes emphasizes the exceptional therapeutic potential of new biocompatible intrathecal nonviral gene delivery approaches such as PLGA microparticles. Ultimately, ongoing expression of therapeutic genes is a viable option to treat chronic neuropathic pain in the clinic. © 2012 International Neuromodulation Society.

  2. Splice-Switching Therapy for Spinal Muscular Atrophy

    Directory of Open Access Journals (Sweden)

    Katharina E. Meijboom

    2017-06-01

    Full Text Available Spinal muscular atrophy (SMA is a genetic disorder with severity ranging from premature death in infants to restricted motor function in adult life. Despite the genetic cause of this disease being known for over twenty years, only recently has a therapy been approved to treat the most severe form of this disease. Here we discuss the genetic basis of SMA and the subsequent studies that led to the utilization of splice switching oligonucleotides to enhance production of SMN protein, which is absent in patients, through a mechanism of exon inclusion into the mature mRNA. Whilst approval of oligonucleotide-based therapies for SMA should be celebrated, we also discuss some of the limitations of this approach and alternate genetic strategies that are currently underway in clinical trials.

  3. The quantity and quality of complementary and alternative medicine clinical practice guidelines on herbal medicines, acupuncture and spinal manipulation: systematic review and assessment using AGREE II.

    Science.gov (United States)

    Ng, Jeremy Y; Liang, Laurel; Gagliardi, Anna R

    2016-10-29

    Complementary and alternative medicine (CAM) use is often not disclosed by patients, and can be unfamiliar to health care professionals. This may lead to underuse of beneficial CAM therapies, and overuse of other CAM therapies with little proven benefit or known contraindications. No prior research has thoroughly evaluated the credibility of knowledge-based resources. The purpose of this research was to assess the quantity and quality of CAM guidelines. A systematic review was conducted to identify CAM guidelines. MEDLINE, EMBASE and CINAHL were searched in January 2016 from 2003 to 2015. The National Guideline Clearinghouse, National Center for Complementary and Integrative Health web site, and two CAM journals were also searched. Eligible guidelines published in English language by non-profit agencies on herbal medicine, acupuncture, or spinal manipulation for adults with any condition were assessed with the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. From 3,126 unique search results, 17 guidelines (two herbal medicine, three acupuncture, four spinal manipulation, eight mixed CAM therapies) published in 2003 or later and relevant to several clinical conditions were eligible. Scaled domain percentages from highest to lowest were clarity of presentation (85.3 %), scope and purpose (83.3 %), rigour of development (61.2 %), editorial independence (60.1 %), stakeholder involvement (52.0 %) and applicability (20.7 %). Quality varied within and across guidelines. None of the 17 guidelines were recommended by both appraisers; 14 were recommended as Yes or Yes with modifications. Guidelines that scored well could be used by patients and health care professionals as the basis for discussion about the use of these CAM therapies. In future updates, guidelines that achieved variable or lower scores could be improved according to specifications in the AGREE II instrument, and with insight from a large number of resources that are available

  4. Rapid cell separation with minimal manipulation for autologous cell therapies

    Science.gov (United States)

    Smith, Alban J.; O'Rorke, Richard D.; Kale, Akshay; Rimsa, Roberts; Tomlinson, Matthew J.; Kirkham, Jennifer; Davies, A. Giles; Wälti, Christoph; Wood, Christopher D.

    2017-02-01

    The ability to isolate specific, viable cell populations from mixed ensembles with minimal manipulation and within intra-operative time would provide significant advantages for autologous, cell-based therapies in regenerative medicine. Current cell-enrichment technologies are either slow, lack specificity and/or require labelling. Thus a rapid, label-free separation technology that does not affect cell functionality, viability or phenotype is highly desirable. Here, we demonstrate separation of viable from non-viable human stromal cells using remote dielectrophoresis, in which an electric field is coupled into a microfluidic channel using shear-horizontal surface acoustic waves, producing an array of virtual electrodes within the channel. This allows high-throughput dielectrophoretic cell separation in high conductivity, physiological-like fluids, overcoming the limitations of conventional dielectrophoresis. We demonstrate viable/non-viable separation efficacy of >98% in pre-purified mesenchymal stromal cells, extracted from human dental pulp, with no adverse effects on cell viability, or on their subsequent osteogenic capabilities.

  5. Manipulators

    International Nuclear Information System (INIS)

    Andre, Y.; Routelous, F.; Spina, G.; Perpina, J.; Suquet, J.; Rossi, M.; Zanca, M.; Billiet, A.; Madec, L.; Lemoine, T.; Gaboriaud, G.; Aubert, B.; Rosenwald, J.C.; Neuenschwander, S.; Brisse, H.; Rehel, J.L.; Rebibo, G.; Bensimon, J.L.; Kulski, A.; Serhal, M.; Nguyen, K.V.; Lescure, R.; Cymbalista, M.

    2005-01-01

    Three articles have for purpose the radiation doses optimization in medical imaging. The first one concerns the radiation protection of manipulators working at a PET scan post, the second one concerns more particularly the optimization of doses delivered in pediatric computerized tomography, the third one is devoted to a comparison between radiation dose and image quality through scanners of adult temporal bone. (N.C.)

  6. Acute electromyographic responses of deep thoracic paraspinal muscles to spinal manual therapy interventions. An experimental, randomized cross-over study.

    Science.gov (United States)

    Fryer, Gary; Bird, Michael; Robbins, Barry; Johnson, Jane C

    2017-07-01

    This single group, randomized, cross-over study explored whether manual therapy alters motor tone of deep thoracic back muscles by examining resting electromyographic activity (EMG) after 2 types of manual therapy and a sham control intervention. Twenty-two participants with thoracic spinal pain (15 females, 7 males, mean age 28.1 ± 6.4 years) had dual fine-wire, intramuscular electrodes inserted into deep transversospinalis muscles at a thoracic level where tissues appeared abnormal to palpation (AbP) and at 2 sites above and below normal and non-tender to palpation (NT). A surface electrode was on the contralateral paraspinal mass at the level of AbP. EMG signals were recorded for resting prone, two 3-s free neck extension efforts, two 3-s resisted maximal voluntary isometric contractions (MVIC), and resting prone before the intervention. Randomized spinal manipulation, counterstrain, or sham manipulation was delivered and EMG re-measured. Participants returned 1 and 2 weeks later for the remaining 2 treatments. Reductions in resting EMG followed counterstrain in AbP (median decrease 3.3%, P = 0.01) and NT sites (median decrease 1.0%, P = 0.05) and for the surface electrode site (median decrease 2.0%, P = 0.009). Reduction in EMG following counterstrain during free neck extension was found for the surface electrode site (median decrease 2.7%, P < 0.01). Spinal manipulation produced no change in EMG, whereas counterstrain technique produced small significant reductions in paraspinal muscle activity during prone resting and free neck extension conditions. The clinical relevance of these changes is unclear. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Chiropractic manipulative therapy of the thoracic spine in combination with stretch and strengthening exercises, in improving postural kyphosis in woman

    Directory of Open Access Journals (Sweden)

    Kim C. Branco

    2016-10-01

    Method: A randomised study design with thirty female participants between the ages of twenty and  thirty nine was selected. Group 1 (n = 10 received chiropractic spinal manipulative therapy to the thoracic spine. Group 2 (n = 10 received chiropractic spinal manipulative therapy to the thoracic spine as well as stretch and strengthening exercises i.e. stretching the pectoralis major muscles and strengthening the rhomboid, middle and inferior trapezius muscles. Group 3 (n = 10 received stretch and strengthening exercises. The stretch and strengthening exercises were performed in the consultation rooms to ensure that the participants were complying with the treatment and doing the exercises properly. The study consisted of seven consultations for Group 1 (they received treatment once a week for six weeks and for Groups 2 and 3 there were nineteen consultations (they received three treatments a week for six weeks. Objective data was recorded at the beginning of the first, fourth and seventh consultations for Group 1, and the first, tenth and nineteenth consultations for Groups 2 and 3. On the seventh consultation (for Group 1 and nineteenth consultation for Groups 2 and 3, only data collection was done. Objective data were obtained by using the Flexicurve® Ruler measurements for the angle of kyphosis. Visual analysis was done by taking lateral (sagittal view photographs at the beginning of the initial and final consultations. Results: Statistical analysis revealed significant statistical changes for the intragroup results for all three groups. No significant statistical difference was found between the groups for the inter-group analysis. Conclusion: The study showed that all three treatment protocols for Groups 1, 2, and 3 were effective. However, Group 1 had not shown a great improvement in their postural kyphosis, Group 3 had shown a relatively good improvement in their posture, while Group 2 had shown the best results with regards to improvement of the

  8. The effect of metallic implants on radiation therapy in spinal tumor patients with metallic spinal implants.

    Science.gov (United States)

    Son, Seok Hyun; Kang, Young Nam; Ryu, Mi-Ryeong

    2012-01-01

    The aim of this study was to evaluate the effect of metallic implants on the dose calculation for radiation therapy in patients with metallic implants and to find a way to reduce the error of dose calculation. We made a phantom in which titanium implants were inserted into positions similar to the implant positions in spinal posterior/posterolateral fusion. We compared the calculated dose of the treatment planning systems with the measured dose in the treatment equipment. We used 3 kinds of computed tomography (CT) (kilovoltage CT, extended-scaled kilovoltage CT, and megavoltage CT) and 3 kinds of treatment equipment (ARTISTE, TomoTherapy Hi-Art, and Cyberknife). For measurement of doses, we used an ionization chamber and Gafchromic external beam therapy film. The absolute doses that were measured using an ionization chamber at the isocenter in the titanium phantom were on average 1.9% lower than those in the reference phantom (p = 0.002). There was no statistically significant difference according to the kinds of CT images, the treatment equipment, and the size of the targets. As the distance from the surface of the titanium implants became closer, the measured doses tended to decrease (p metallic implants was less in the megavoltage CT than in the kilovoltage CT or the extended-scaled kilovoltage CT. The error caused by the titanium implants was beyond a clinically acceptable range. To reduce the error of dose calculation, we suggest that the megavoltage CT be used for planning. In addition, it is necessary to consider the distance between the titanium implants and the targets or the organs at risk to prescribe the dose for the target and the dose constraint for the organs at risk. Copyright © 2012 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  9. Early Tissue Effects of Stereotactic Body Radiation Therapy for Spinal Metastases

    NARCIS (Netherlands)

    Steverink, Jasper G.; Willems, Stefan M.; Philippens, Marielle E.P.; Kasperts, Nicolien; Eppinga, Wietse S.C.; Versteeg, Anne L.; van der Velden, Joanne M.; Faruqi, Salman; Sahgal, Arjun; Verlaan, Jorrit Jan

    2018-01-01

    Purpose: Stereotactic body radiation therapy (SBRT) is a highly effective and potentially ablative treatment for complex spinal metastases. Recent data have suggested radiobiologic effects of SBRT that expand beyond the traditional concept of DNA damage. Antitumor immunity, vascular damage leading

  10. The Radiation Therapy for Spinal Cord Compression in Hematologic Malignancy

    International Nuclear Information System (INIS)

    Kim, In Ah; Choi, Ihl Bohng; Chung, Su Mi

    1994-01-01

    Spinal cord compression, an oncologic emergency, is a rare complication of hematologic malignancy. Our experience was obtained with a series 32 patients following retrospective analysis for assessing the role of radiation therapy and identifying the prognostic factors affecting on treatment outcome. Diagnosis was usually made by means of radiologic study such as myelography or computerized tomography (CT) or magnetic resonance imaging (MRI) and neurologic examination. Five cases were diagnosed by subjective symptom only with high index of suspicion. In 31 cases, the treatment consisted in radiation therapy alone and the remained one patient had laminectomy before radiation therapy because of diagnostic doubts. Total treatment doses ranged from 800 cGy to 4000 cGy with median of 2999 cGy. Initially large fraction size more than 250 cGy were used in 13 patients with rapidly progressed neurologic deficit. The clinical parameters considered in evaluating the response to treatment were backache, motor-sensory performance and sphincter function. Half on all patients showed good response. Partial response and no response were noted in 37.5% and 12.5%, respectively. Our results showed higher response rate than those of other solid tumor series. The degree of neurologic deficit an that time of diagnosis was the most important predictor of treatment outcome. The elapsed time from development of symptoms to start of treatment was significantly affected on the outcome. But histology of primary tumor, total dose and use of initial large fraction size were not significantly affect on the outcome. These results confirmed the value of early diagnosis and treatment especially in radiosensitive hematologic malignancy

  11. A Clinical Observation of Functional Abdominal Pain Syndrome in Patients Treated by Traditional Chinese Spinal Orthopedic Manipulation.

    Science.gov (United States)

    Qu, Liu-Xin; Xing, Li-Yang; Wanda, Norman; Chen, Hong; Li, Ming-Ju; Gao, Song; Li, Ping

    2018-02-01

    To evaluate the clinical effect of traditional Chinese spinal orthopedic manipulation (TCSOM) in treating patients with functional abdominal pain syndrome (FAPS) in comparison with Pinaverium Bromide (Dicetel, PBD), and to assess a possible cause for FAPS. Eighty patients with FAPS were randomly and equally assigned to the TCSOM group and PBD group according to the random number table. All patients in the TCSOM group were treated with a maximum of 5 times of spinal manipulations. Patients in the PBD group were instructed to take 50 mg 3 times a day, consistently for 2 weeks. The symptoms of pre- and post-treatment were assessed on a visual analog scale (VAS) pain score. A symptom improvement rating (SIR) was implemented to evaluate the effects of the treatments. The symptoms of 27 cases of the TCSOM group were relieved soon after the first TCSOM treatment and 9 cases were significantly improved. The VAS pain scores in the TCSOM group were significantly lower than those in the PBD group after 2 weeks treatment. According to the SIR based on VAS, the TCSOM group included 30 cases with excellent results, 7 cases with good, and 3 cases with poor. Adverse events to the treatment were not reported. Based on VAS, the PBD group reported 8 cases with excellent results, 10 cases with good and 22 cases with poor. There was a significant difference between the two groups (P<0.01). The displacement of intervertebral discs and/or vertebra in the thoracic or lumbar region seems to be a contributing factor in the symptoms of FAPS. TCSOM is an effective treatment for FAPS.

  12. Cell Therapy in Spinal Cord Injury: a Mini- Reivew

    Directory of Open Access Journals (Sweden)

    Soraya Mehrabi

    2013-04-01

    Full Text Available Spinal cord injury (SCI is a debilitating disease which leads to progressive functional damages. Because of limited axonal regeneration in the central nervous system, there is no or little recovery expected in the patients. Different cellular and molecular approaches were investigated in SCI animal models. Cellular transplantation of stem cells can potentially replace damaged tissue and provide a suitable microenvironment for axons to regenerate. Here, we reviewed the last approaches applied by our colleagues and others in order to improve axonal regeneration following SCI. We used different types of stem cells via different methods. First, fetal olfactory mucosa, schwann, and bone marrow stromal cells were transplanted into the injury sites in SCI models. In later studies, was applied simultaneous transplantation of stem cells with chondroitinase ABC in SCI models with the aid of nanoparticles. Using these approaches, considerable functional recovery was observed. However, considering some challenges in stem cell therapy such as rejection, infection, and development of a new cancer, our more recent strategy was application of cytokines. We observed a significant improvement in motor function of rats when stromal derived factor-1 was used to attract innate stem cells to the injury site. In conclusion, it seems that co-transplantation of different cells accompanies with other factors like enzymes and growth factors via new delivery systems may yield better results in SCI.

  13. Design Issues and Application of Cable-Based Parallel Manipulators for Rehabilitation Therapy

    Directory of Open Access Journals (Sweden)

    E. Ottaviano

    2008-01-01

    Full Text Available In this study, cable-based manipulators are proposed for application in rehabilitation therapies. Cable-based manipulators show good features that are very useful when the system has to interact with humans. In particular, they can be used to aid motion or as monitoring/training systems in rehabilitation therapies. Modelling and simulation of both active and passive cable-based parallel manipulators are presented for an application to help older people, patients or disabled people in the sit-to-stand transfer and as a monitoring/training system. Experimental results are presented by using built prototypes.

  14. Spinal cord stimulation therapy for localized central pain

    International Nuclear Information System (INIS)

    Hirato, Masafumi; Takahashi, Akio; Watanabe, Katsushige; Kazama, Ken; Yoshimoto, Yuhei

    2008-01-01

    We studied the pathophysiology of localized central pain and the surgical result of spinal cord stimulation. There were 10 cases; 7 males and 3 females from 24 to 77 years old. Pain was caused by peripheral nerve injury in one case, spinal cord injury in two cases and cerebrovascular disease (CVD) (thalamic pain) in 7 cases. All cases were treated by epidural spinal cord stimulation and followed from 0.8 to 8.8 years. Sufficient pain relief was achieved in one case of peripheral nerve and spinal cord injury and in 4 cases of CVD. Moderate pain control was achieved in 2 cases of CVD. In one each case of spinal cord injury and of CVD, pain control was ineffective. In cases with thalamic pain, we studied the correlation between the surgical result of spinal cord stimulation and the clinical features, MRI, fluoro-deoxyglucose (FDG)-positron emission tomography (PET), and somatosensory evoked potentials (SEP) findings before operation. MRI revealed a small to moderate sized lesion on the thalamus or putamen in each case. PET also showed decreased accumulation of FDG on the affected thalamus. In all cases without one fair responder to spinal cord stimulation, we could recognize definite SEP originating in the sensory cortex ipsilateral side to the CVD lesion during contralateral median or posterior tibial nerve stimulation. In the good responders, we could recognize SEP originating in the sensory cortex of the lesion side with less delayed latency or decreased amplitude than in the moderate responders. In this group, test stimulation with low voltage on the spinal cord evoked a sensory effect (paresthesia) over the painful part of the body. Spinal cord stimulation proved to be an effective treatment for localized central pain. In cases with localized central pain after CVD, we could expect to ameliorate the intractable pain in those cases in which SEP or spinal cord test stimulation revealed that the thalamo-cortical system was preserved. (author)

  15. Spinal plasticity in robot-mediated therapy for the lower limbs

    DEFF Research Database (Denmark)

    Stevenson, Andrew James Thomas; Mrachacz-Kersting, Natalie; van Asseldonk, Edwin

    2015-01-01

    of neural changes in the spinal cord. Here, we review the recent literature on spinal plasticity induced by robotic-based training in humans and propose recommendations for the measurement of spinal plasticity using robotic devices. Evidence for spinal plasticity in humans following robotic training...... but are not part of robotic devices used for training purposes. A further development of robotic devices that include the technology to elicit stretch reflexes would allow for the spinal circuitry to be routinely tested as a part of the training and evaluation protocols.......Robot-mediated therapy can help improve walking ability in patients following injuries to the central nervous system. However, the efficacy of this treatment varies between patients, and evidence for the mechanisms underlying functional improvements in humans is poor, particularly in terms...

  16. Magnetic resonance imaging zygapophyseal joint space changes (gapping) in low back pain patients following spinal manipulation and side-posture positioning: a randomized controlled mechanisms trial with blinding.

    Science.gov (United States)

    Cramer, Gregory D; Cambron, Jerrilyn; Cantu, Joe A; Dexheimer, Jennifer M; Pocius, Judith D; Gregerson, Douglas; Fergus, Michael; McKinnis, Ray; Grieve, Thomas J

    2013-05-01

    The purpose of this study was to quantify lumbar zygapophyseal (Z) joint space separation (gapping) in low back pain (LBP) subjects after spinal manipulative therapy (SMT) or side-posture positioning (SPP). This was a controlled mechanisms trial with randomization and blinding. Acute LBP subjects (N = 112; four n = 28 magnetic resonance imaging [MRI] protocol groups) had 2 MRI appointments (initial enrollment and after 2 weeks of chiropractic treatment, receiving 2 MRI scans of the L4/L5 and L5/S1 Z joints at each MRI appointment. After the first MRI scan of each appointment, subjects were randomized (initial enrollment appointment) or assigned (after 2 weeks of chiropractic treatment appointment) into SPP (nonmanipulation), SMT (manipulation), or control MRI protocol groups. After SPP or SMT, a second MRI was taken. The central anterior-posterior joint space was measured. Difference between most painful side anterior-posterior measurements taken postintervention and preintervention was the Z joint "gapping difference." Gapping differences were compared (analysis of variance) among protocol groups. Secondary measures of pain (visual analog scale, verbal numeric pain rating scale) and function (Bournemouth questionnaire) were assessed. Gapping differences were significant at the first (adjusted, P = .009; SPP, 0.66 ± 0.48 mm; SMT, 0.23 ± 0.86; control, 0.18 ± 0.71) and second (adjusted, P = .0005; SPP, 0.65 ± 0.92 mm; SMT, 0.89 ± 0.71; control, 0.35 ± 0.32) MRI appointments. Verbal numeric pain rating scale differences were significant at first MRI appointment (P = .04) with SMT showing the greatest improvement. Visual analog scale and Bournemouth questionnaire improved after 2 weeks of care in all groups (both P posture positioning showed greatest gapping at baseline. After 2 weeks, SMT resulted in greatest gapping. Side-posture positioning appeared to have additive therapeutic benefit to SMT. Copyright © 2013 National University of Health Sciences

  17. Osteopathic manipulative treatment results in sustained relief from spinal pain in older patients: A pilot crossover study

    Directory of Open Access Journals (Sweden)

    Pannunzio A

    2016-01-01

    Full Text Available Osteopathic Manipulative Treatment is commonly used to complement conventional treatment of back pain. The present study verified whether OMT, associated with training program, reduces spinal pain in older. A pilot randomized, double-blind crossover study was conducted at Sport Association of Milan, Italy. We recruited 19 subjects above 60 years old, with presence of SP for more than 3 weeks and with intensity score higher than 3 (NRS score. All patients underwent a multi-component group exercise program for older adults and were randomized in two groups: in the study group (SG OMT was added, while the control group (CG continued with the exercise only. After 6 weeks a crossover was applied to the 2 groups and OMT was added to CG, while SG continued with the exercise only. Self-reported measures: the Numeric Rating Scale (NRS was used at each time to evaluate treatment outcomes. At pre-crossover, SG had a significant improvement in pain perception (p<0.05, while CG had a not significate improvement in pain perception (p=0.33.At post-crossover, the SG remains relatively stable (p=0.37, while CG after OMT addition have a significant benefit on pain perception (p=0.001. At follow-up, pain improvement is sustained (p=0.32. OMT associated to exercise reduce spinal pain in older patients. Our study suggests that OMT associated to exercise leads to significant improvement on pain relief in patients with chronic SP in a short term and the exercise allows to maintain these improvements for several months

  18. Understanding inhibitory mechanisms of lumbar spinal manipulation using H-reflex and F-wave responses: a methodological approach.

    Science.gov (United States)

    Dishman, J Donald; Weber, Kenneth A; Corbin, Roger L; Burke, Jeanmarie R

    2012-09-30

    The purpose of this research was to characterize unique neurophysiologic events following a high velocity, low amplitude (HVLA) spinal manipulation (SM) procedure. Descriptive time series analysis techniques of time plots, outlier detection and autocorrelation functions were applied to time series of tibial nerve H-reflexes that were evoked at 10-s intervals from 100 s before the event until 100 s after three distinct events L5-S1 HVLA SM, or a L5-S1 joint pre-loading procedure, or the control condition. Sixty-six subjects were randomly assigned to three procedures, i.e., 22 time series per group. If the detection of outliers and correlograms revealed a pattern of non-randomness that was only time-locked to a single, specific event in the normalized time series, then an experimental effect would be inferred beyond the inherent variability of H-reflex responses. Tibial nerve F-wave responses were included to determine if any new information about central nervous function following a HVLA SM procedure could be ascertained. Time series analyses of H(max)/M(max) ratios, pre-post L5-S1 HVLA SM, substantiated the hypothesis that the specific aspects of the manipulative thrust lead to a greater attenuation of the H(max)/M(max) ratio as compared to the non-specific aspects related to the postural perturbation and joint pre-loading. The attenuation of the H(max)/M(max) ratio following the HVLA SM procedure was reliable and may hold promise as a translational tool to measure the consistency and accuracy of protocol implementation involving SM in clinical trials research. F-wave responses were not sensitive to mechanical perturbations of the lumbar spine. Copyright © 2012 Elsevier B.V. All rights reserved.

  19. Plasticity and regeneration in the injured spinal cord after cell transplantation therapy.

    Science.gov (United States)

    Nori, Satoshi; Nakamura, Masaya; Okano, Hideyuki

    2017-01-01

    Spinal cord injury (SCI) typically damages the long axonal tracts of the spinal cord which results in permanent disability. However, regeneration of the injured spinal cord is approaching reality according to the advances in stem cell biology. Cell transplantation therapy holds potential to lead to recovery following SCI through some positive mechanisms. Grafted cells induce plasticity and regeneration in the injured spinal cord by promoting remyelination of damaged axons, reconstruction of neural circuits by synapse formation between host neurons and graft-derived neurons, and secreting neurotrophic factors to promote axonal elongation as well as reduce retrograde axonal degeneration. In this review, we will delineate (1) the microenvironment of the injured spinal cord that influence the plasticity and regeneration capacity after SCI, (2) a number of different kinds of cell transplantation therapies for SCI that has been extensively studied by researchers, and (3) potential mechanisms of grafted cell-induced regeneration and plasticity in the injured spinal cord. © 2017 Elsevier B.V. All rights reserved.

  20. Manipulation of Auditory Inputs as Rehabilitation Therapy for Maladaptive Auditory Cortical Reorganization

    Directory of Open Access Journals (Sweden)

    Hidehiko Okamoto

    2018-01-01

    Full Text Available Neurophysiological and neuroimaging data suggest that the brains of not only children but also adults are reorganized based on sensory inputs and behaviors. Plastic changes in the brain are generally beneficial; however, maladaptive cortical reorganization in the auditory cortex may lead to hearing disorders such as tinnitus and hyperacusis. Recent studies attempted to noninvasively visualize pathological neural activity in the living human brain and reverse maladaptive cortical reorganization by the suitable manipulation of auditory inputs in order to alleviate detrimental auditory symptoms. The effects of the manipulation of auditory inputs on maladaptively reorganized brain were reviewed herein. The findings obtained indicate that rehabilitation therapy based on the manipulation of auditory inputs is an effective and safe approach for hearing disorders. The appropriate manipulation of sensory inputs guided by the visualization of pathological brain activities using recent neuroimaging techniques may contribute to the establishment of new clinical applications for affected individuals.

  1. 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

  2. Hormonal therapy with external radiation therapy for metastatic spinal cord compression from newly diagnosed prostate cancer

    International Nuclear Information System (INIS)

    Kato, So; Hozumi, Takahiro; Yamakawa, Kiyofumi; Higashikawa, Akiro; Goto, Takahiro; Shinohara, Mitsuru; Kondo, Taiji

    2013-01-01

    Although hormonal therapy is effective for treatment of prostate cancer, its effect in the treatment of metastatic spinal cord compression (MSCC) has not been established. The objective of this study was to clarify the efficacy of conservative treatment of MSCC-induced paralysis resulting from prostate cancer for patients without a previous treatment history. We reviewed data from 38 patients with MSCC-induced paralysis from newly diagnosed prostate cancer who presented to our service between 1984 and 2010. Conservative treatment consisted of hormonal therapy with external radiation therapy (ERT). Patient demographic data, treatment details, involved spine MRI images, complications, and the course of neurologic recovery were investigated. Twenty-five patients were treated conservatively. Mean follow-up period was 36.8 months. Sixteen patients (two with Frankel B, 14 with Frankel C) were unable to walk at initial presentation. After initiating conservative treatment, 75% (12 of 16) of these patients regained the ability to walk within 1 month, 88% (14 in 16) did so within 3 months, and all non-ambulatory patients did so within 6 months. No one had morbid complications. Four patients who did not regain the ability to walk at 1 month were found to have progressed to paraplegia rapidly, and tended to have severe compression as visualized on MRI, with a delay in the start of treatment in comparison with those who did so within 1 month (21.0 vs. 7.8 days). Hormonal therapy associated with ERT is an important option for treatment of MSCC resulting from newly diagnosed prostate cancer. (author)

  3. A preliminary path analysis of expectancy and patient-provider encounter in an open-label randomized controlled trial of spinal manipulation for cervicogenic headache.

    Science.gov (United States)

    Haas, Mitchell; Aickin, Mikel; Vavrek, Darcy

    2010-01-01

    The purpose of this article was to present a preliminary model to identify the effects of expectancy of treatment success and the patient-provider encounter (PPE) on outcomes in an open-label randomized trial. Eighty participants with chronic cervicogenic headache (CGH) were randomized to 4 groups: 2 levels of treatment dose (8 or 16) and 2 levels of therapy from a chiropractor (spinal manipulation or light massage). Providers were instructed to have equal enthusiasm for all care. Structural equation modeling with standardized path coefficients (beta) was used in a path analysis to identify the effects of patient expectancy and the PPE on CGH pain. The model included monthly pain from baseline to 12 weeks. Expectancy and PPE were evaluated on Likert scales. The patient-provider encounter was measured as patient perception of chiropractor enthusiasm, confidence, and comfort with care. Baseline patient expectancy was balanced across groups. The PPE measures were balanced across groups and consistent over the 8-week treatment period. Treatment and baseline pain had the strongest effects on pain outcomes (|beta| = .46-.59). Expectations had little effect on pain (abs value(beta) value(beta)= .03-.27) and on subsequent confidence in treatment success (abs value(beta)= .09 and .12). Encouraging equipoise in the PPE and balancing expectancy across treatment groups may protect against some confounding related to the absence of blinding in a randomized controlled trial of pain. In this trial, their effects were found to be small relative to the effects of treatment and baseline values. Copyright 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  4. Demonstrating Efficacy in Preclinical Studies of Cellular Therapies for Spinal Cord Injury - How Much is Enough?

    Czech Academy of Sciences Publication Activity Database

    Kwon, B. K.; Soril, L. J. J.; Bacon, M.; Beattie, M. S.; Blesch, A.; Bresnahan, J. C.; Bunge, M. B.; Dunlop, S. A.; Fehlings, M. G.; Ferguson, A. R.; Hill, C. E.; Karimi-Abdolrezaee, S.; Lu, P.; McDonald, J. W.; Müller, H. W.; Oudega, M.; Rosenzweig, E. S.; Reier, P. J.; Silver, J.; Syková, Eva; Xu, X. M.; Guest, J. D.; Tetzlaff, W.

    2013-01-01

    Roč. 248, Oct (2013), s. 30-44 ISSN 0014-4886 R&D Projects: GA ČR GA13-00939S; GA ČR(CZ) GBP304/12/G069 Institutional support: RVO:68378041 Keywords : spinal cord injury * cell transplantation therapies * clinical trial Subject RIV: FH - Neurology Impact factor: 4.617, year: 2013

  5. Aquatic Therapy for a Child with Type III Spinal Muscular Atrophy: A Case Report

    Science.gov (United States)

    Salem, Yasser; Gropack, Stacy Jaffee

    2010-01-01

    Spinal muscular atrophy (SMA) is a neuromuscular disorder characterized by degeneration of alpha motor neurons. This case report describes an aquatic therapy program and the outcomes for a 3-year-old girl with type III SMA. Motor skills were examined using the 88-item Gross Motor Function Measure (GMFM), the Peabody Developmental Motor Scales…

  6. A randomised controlled trial of preventive spinal manipulation with and without a home exercise program for patients with chronic neck pain

    Directory of Open Access Journals (Sweden)

    Descarreaux Martin

    2011-02-01

    Full Text Available Abstract Background Evidence indicates that supervised home exercises, combined or not with manual therapy, can be beneficial for patients with non-specific chronic neck pain (NCNP. The objective of the study is to investigate the efficacy of preventive spinal manipulative therapy (SMT compared to a no treatment group in NCNP patients. Another objective is to assess the efficacy of SMT with and without a home exercise program. Methods Ninety-eight patients underwent a short symptomatic phase of treatment before being randomly allocated to either an attention-group (n = 29, a SMT group (n = 36 or a SMT + exercise group (n = 33. The preventive phase of treatment, which lasted for 10 months, consisted of meeting with a chiropractor every two months to evaluate and discuss symptoms (attention-control group, 1 monthly SMT session (SMT group or 1 monthly SMT session combined with a home exercise program (SMT + exercise group. The primary and secondary outcome measures were represented by scores on a 10-cm visual analog scale (VAS, active cervical ranges of motion (cROM, the neck disability index (NDI and the Bournemouth questionnaire (BQ. Exploratory outcome measures were scored on the Fear-avoidance Behaviour Questionnaire (FABQ and the SF-12 Questionnaire. Results Our results show that, in the preventive phase of the trial, all 3 groups showed primary and secondary outcomes scores similar to those obtain following the non-randomised, symptomatic phase. No group difference was observed for the primary, secondary and exploratory variables. Significant improvements in FABQ scores were noted in all groups during the preventive phase of the trial. However, no significant change in health related quality of life (HRQL was associated with the preventive phase. Conclusions This study hypothesised that participants in the combined intervention group would have less pain and disability and better function than participants from the 2 other groups during the

  7. Human neural stem cell replacement therapy for amyotrophic lateral sclerosis by spinal transplantation.

    Directory of Open Access Journals (Sweden)

    Michael P Hefferan

    clinically-adequate treatment, cell-replacement/gene therapy strategies will likely require both spinal and supraspinal targets.

  8. Dental Apical Papilla as Therapy for Spinal Cord Injury.

    Science.gov (United States)

    De Berdt, P; Vanacker, J; Ucakar, B; Elens, L; Diogenes, A; Leprince, J G; Deumens, R; des Rieux, A

    2015-11-01

    Stem cells of the apical papilla (SCAP) represent great promise regarding treatment of neural tissue damage, such as spinal cord injury (SCI). They derive from the neural crest, express numerous neurogenic markers, and mediate neurite outgrowth and axonal targeting. The goal of the present work was to investigate for the first time their potential to promote motor recovery after SCI in a rat hemisection model when delivered in their original stem cell niche-that is, by transplantation of the human apical papilla tissue itself into the lesion. Control groups consisted of animals subjected to laminectomy only (shams) and to lesion either untreated or injected with a fibrin hydrogel with or without human SCAP. Basso-Beattie-Bresnahan locomotor scores at 1 and 3 d postsurgery confirmed early functional decline in all SCI groups. This significant impairment was reversed, as seen in CatWalk analyses, after transplantation of apical papilla into the injured spinal cord wound, whereas the other groups demonstrated persistent functional impairment. Moreover, tactile allodynia did not develop as an unwanted side effect in any of the groups, even though the SCAP hydrogel group showed higher expression of the microglial marker Iba-1, which has been frequently associated with allodynia. Notably, the apical papilla transplant group presented with reduced Iba-1 expression level. Masson trichrome and human mitochondria staining showed the preservation of the apical papilla integrity and the presence of numerous human cells, while human cells could no longer be detected in the SCAP hydrogel group at the 6-wk postsurgery time point. Altogether, our data suggest that the transplantation of a human apical papilla at the lesion site improves gait in spinally injured rats and reduces glial reactivity. It also underlines the potential interest for the application of delivering SCAP in their original niche, as compared with use of a fibrin hydrogel. © International & American

  9. Morbidity associated with heparin therapy in spinal surgery patients with cardiovascular diseases

    International Nuclear Information System (INIS)

    Sawakami, Kimihiko; Ishikawa, Seiichi; Ito, Takui

    2011-01-01

    The objectives of this study were to investigate morbidity associated with heparin therapy in spinal surgery patients. The management of patients on anticoagulant therapy who undergo spinal surgery is becoming a common clinical problem. Although guidelines for the management of gastrointestinal endoscopy patients on heparin therapy have been published, spinal surgery may lead to specific complications, especially because of heparin therapy. However, only few studies have examined the clinical significance of heparin therapy in spinal surgery patients. The subjects of this study were 116 consecutive patients who were on anticoagulant or antiplatelet therapy. This says that all of the patients were receiving heparin or another anticoagunt. The patients were divided into 2 groups: a group that received heparin therapy before and after surgery (H group, n=25) and a group that did not receive heparin therapy (NH group, n=91). The results of clinical examinations and magnetic resonance imaging (MRI) in the 2 groups were compared. There were no significant differences between the 2 groups in baseline data. Comorbidities in both groups included valvular heart disease, atrial fibrillation, angina pectoris/myocardial infarction, and cerebral infarction. Mean intraoperative and postoperative blood loss in the H group were 324 ml and 536 ml, respectively, and the corresponding values in the NH group were 431 ml and 449 ml, respectively. MRI of all patients was performed within 10 days after surgery and T2-weighted images in the axial plane were examined for evidence of an epidural hematoma. Although the proportion of patients with an epidural hematoma, detected by MRI was higher in the H group than in the NH group (71% vs. 64%), none of the patients in either group required revision surgery because of intolerable pain or muscle weakness. Thrombocytopenia and skin necrosis were observed as complications of the heparin therapy in 1 patient in the H group (4%). The rate of

  10. Effectiveness of radiation therapy for metastatic spinal tumors producing neurologic impairment

    International Nuclear Information System (INIS)

    Yamamoto, Shuichiro; Nomoto, Satoshi; Imada, Hajime; Nakata, Hajime

    2002-01-01

    The purpose of this study was to evaluate the efficacy of radiation therapy (RT) for treating neurological impairment and improving quality of life (QOL) in patients with metastatic spinal tumors. From 1985 through 2001, 75 patients with metastatic spinal tumors were treated with RT. Neurologic status and Karnofsky performance status were assessed before and after RT. The rate of neurologic improvement was significantly higher in patients with radio-sensitive tumors (75%) than in patients with radio-resistant tumors (37%). Few patients with Karnofsky performance status less than 40% before RT had good QOL after RT. The response to RT did not differ significantly on the basis of duration of paralysis before RT. RT is useful for treating neurologic impairment caused by metastatic spinal tumors, particularly those that are radiosensitive. To have good QOL after RT, treatment should be started in the early stage of neurological impairment. (author)

  11. Advances in regenerative therapies for spinal cord injury: a biomaterials approach

    Directory of Open Access Journals (Sweden)

    Magdalini Tsintou

    2015-01-01

    Full Text Available Spinal cord injury results in the permanent loss of function, causing enormous personal, social and economic problems. Even though neural regeneration has been proven to be a natural mechanism, central nervous system repair mechanisms are ineffective due to the imbalance of the inhibitory and excitatory factors implicated in neuroregeneration. Therefore, there is growing research interest on discovering a novel therapeutic strategy for effective spinal cord injury repair. To this direction, cell-based delivery strategies, biomolecule delivery strategies as well as scaffold-based therapeutic strategies have been developed with a tendency to seek for the answer to a combinatorial approach of all the above. Here we review the recent advances on regenerative/neural engineering therapies for spinal cord injury, aiming at providing an insight to the most promising repair strategies, in order to facilitate future research conduction.

  12. Spinal cordd biological safety comparison of intensity modulated radiotherapy and conventional radiation therapy

    International Nuclear Information System (INIS)

    Xilinbaoleri; Xu Wanlong; Chen Gang; Liu Hao; Wang Ruozheng; Bai Jingping

    2010-01-01

    Objective: To compare the spine intensity modulated radiation therapy (IMRT) and the conventional radiation therapy on the beagle spinal cord neurons, in order to prove the biological safety of IMRT of the spinal cord. Methods: Twelve selected purebred beagles were randomly divided into 2 groups. A beagle clinical model of tumor was mimiced in the ninth and tenth thoracic vertebrae. Then the beagles were irradiated by 2 different models of intensity modulated radiotherapy and conventional radiation therapy, with the total irradiation doses of 50 and 70 Gy. The samples of spinal cord were taken out from the same position of the nine and tenth thoracic vertebrae at the third month after radiation.All the samples were observed by the electron microscope, and the Fas and HSP70 expression in spinal cord neurons were evaluated by immunohistochemistry method. Terminal deoxynucleatidyl transferase mediated dUTP nick and labeling (TUNEL) technique was used to examine the apoptotic cells in the spinal cord. Results: The neurons in the spinal cord of IMRT group were mainly reversible injury, and those in the conventional radiation therapy were mainly apoptosis. Compared with the conventional radiation therapy group [50 Gy group, (7.3 ± 1.1)%; 70 Gy group, (11.3 ± 1.4)%], the apoptosis rate of the spinal cord neurons of the intensity modulated radiotherapy group [50 Gy group, (1.2 ± 0.7)%; 70 Gy group (2.5 ± 0.8)%] was much lower[(50 Gy group, t=0.022, P<0.05; 70 Gy group, t=0.017, P<0.05)]. The expression levels of Fas in the IMPT group (50 Gy group, 4.6 ± 0.8; 70 Gy group, 7.4 ± 1.1) were also much lowerthan those in the other group (50 Gy group, 15.1 ± 6.4; 70 Gy group, 19.3 ± 7.6. 50 Gy group, t=0.231, P<0.05; 70 Gy group, t=0.457, P<0.05), while the expression levels of HSP70 in the IMPT group (50 Gy group, 9.1 ± 0.8; 70 Gy group, 7.3 ± 1.4)were much higher than those in the conventional radiation therapy group (50 Gy group, 2.1 ± 0.9; 70 Gy group, 1.7 ± 0

  13. Spinal cord stimulation therapy for gait dysfunction in advanced Parkinson's disease patients.

    Science.gov (United States)

    Samotus, Olivia; Parrent, Andrew; Jog, Mandar

    2018-02-14

    Benefits of dopaminergic therapy and deep brain stimulation are limited and unpredictable for axial symptoms in Parkinson's disease. Dorsal spinal cord stimulation may be a new therapeutic approach. The objective of this study was to investigate the therapeutic effect of spinal cord stimulation on gait including freezing of gait in advanced PD patients. Five male PD participants with significant gait disturbances and freezing of gait underwent midthoracic spinal cord stimulation. Spinal cord stimulation combinations (200-500 μs/30-130 Hz) at suprathreshold intensity were tested over a 1- to 4-month period, and the effects of spinal cord stimulation were studied 6 months after spinal cord stimulation surgery. Protokinetics Walkway measured gait parameters. Z scores per gait variable established each participant's best spinal cord stimulation setting. Timed sit-to-stand and automated freezing-of-gait detection using foot pressures were analyzed. Freezing of Gait Questionnaire (FOG-Q), UPDRS motor items, and activities-specific balance confidence scale were completed at each study visit. Spinal cord stimulation setting combinations of 300-400 μs/30-130 Hz provided gait improvements. Although on-medication/on-stimulation at 6 months, mean step length, stride velocity, and sit-to-stand improved by 38.8%, 42.3%, and 50.3%, respectively, mean UPDRS, Freezing of Gait Questionnaire, and activities-specific balance confidence scale scores improved by 33.5%, 26.8%, and 71.4%, respectively. The mean number of freezing-of-gait episodes reduced significantly from 16 presurgery to 0 at 6 months while patients were on levodopa and off stimulation. By using objective measures to detect dynamic gait characteristics, the therapeutic potential of spinal cord stimulation was optimized to each participant's characteristics. This pilot study demonstrated the safety and significant therapeutic outcome of spinal cord stimulation in advanced PD patients, and thus a larger and longer

  14. Effects of polarization in low-level laser therapy of spinal cord injury in rats

    Science.gov (United States)

    Ando, Takahiro; Sato, Shunichi; Kobayashi, Hiroaki; Nawashiro, Hiroshi; Ashida, Hiroshi; Hamblin, Michael R.; Obara, Minoru

    2012-03-01

    Low-level laser therapy (LLLT) is a promising approach to treat the spinal cord injury (SCI). Since nerve fibers have optical anisotropy, propagation of light in the spinal tissue might be affected by its polarization direction. However, the effect of polarization on the efficacy of LLLT has not been elucidated. In the present study, we investigated the effect of polarization on the efficacy of near-infrared LLLT for SCI. Rat spinal cord was injured with a weight-drop device. The lesion site was irradiated with an 808-nm diode laser beam that was transmitted through a polarizing filter immediately after injury and daily for five consecutive days. The laser power at the injured spinal cord surface was 25 mW, and the dosage per day was 9.6 J/cm2 (spot diameter, 2 cm; irradiation duration, 1200 s). Functional recovery was assessed daily by an open-field test. The results showed that the functional scores of the SCI rats that were treated with 808-nm laser irradiation were significantly higher than those of the SCI alone group (Group 1) from day 5 after injury, regardless of the polarization direction. Importantly, as compared to the locomotive function of the SCI rats that were treated with the perpendicularly-polarized laser parallel to the spinal column (Group 2), that of the SCI rats that were irradiated with the linearly aligned polarization (Group 3) was significantly improved from day 10 after injury. In addition, the ATP contents in the injured spinal tissue of Group 3, which were measured immediately after laser irradiation, were moderately higher than those of Group 2. These observations are attributable to the deeper penetration of the parallelpolarized light in the anisotropic spinal tissue, suggesting that polarization direction significantly affects the efficacy of LLLT for SCI.

  15. Comparison of short-term response to two spinal manipulation techniques for patients with low back pain in a military beneficiary population.

    Science.gov (United States)

    Sutlive, Thomas G; Mabry, Lance M; Easterling, Emmanuel J; Durbin, Jose D; Hanson, Stephen L; Wainner, Robert S; Childs, John D

    2009-07-01

    To determine whether military health care beneficiaries with low back pain (LBP) who are likely to respond successfully to spinal manipulation experience a difference in short-term clinical outcomes based on the manipulation technique that is used. Sixty patients with LBP identified as likely responders to manipulation underwent a standardized clinical examination and were randomized to receive a lumbopelvic (LP) or lumbar neutral gap (NG) manipulation technique. Outcome measures were a numeric pain rating scale and the modified Oswestry Disability Questionnaire. Both the LP and NG groups experienced statistically significant reductions in pain and disability at 48 hours postmanipulation. The improvements seen in each group were small because of the short follow-up. There were no statistically significant or clinically meaningful differences in pain or disability between the two groups. The two manipulation techniques used in this study were equally effective at reducing pain and disability when compared at 48 hours posttreatment. Clinicians may employ either technique for the treatment of LBP and can expect similar outcomes in those who satisfy the clinical prediction rule (CPR). Further research is required to determine whether differences exist at longer-term follow-up periods, after multiple treatment sessions, or in different clinical populations.

  16. [Acupuncture therapy for regaining consciousness in terms of acupoint location, needle insertion and needle manipulation].

    Science.gov (United States)

    Meng, Xianggang; Gu, Wenlong; Ma, Fen; Du, Yuzheng; Zhao, Qi

    2015-03-01

    Acupuncture therapy for regaining consciousness activates soreness, numbness, distention, heaviness, radiating and moving, electric shock and ant climbing sensations at the specific acupoints in the stroke patients. Radiating and moving sensations are the summary of needling sensations such as soreness, numbness and twitching presenting during lifting and thrusting manipulation. These sensations are the essential factors of the therapeutic effect of regaining consciousness. Radiating sensation refers to the conduction along meridians and radiation of soreness and numbness. Moving sensation refers to the local muscular twitching at acupoints and the involuntary movement of limbs, joints and the distal. Acupuncture at the specific acupoints achieves radiating and moving sensations for promoting the circulation in meridians, regulating qi and mind and balancing yin and yang in stroke patients. This therapy was introduced in the paper in view of acupoint location, needle insertion and manipulation.

  17. Diagnostics and therapy of spinal disc herniation; Diagnostik und Therapie des Bandscheibenvorfalls

    Energy Technology Data Exchange (ETDEWEB)

    Zimmer, A.; Reith, W. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

    2014-11-15

    Degenerative processes in a movement segment of the vertebral column, which can potentially give rise to herniation of elements of the nucleus pulposus, are complex and of variable clinical and radiological dimensions; however the mere assumption that degenerative changes precede disc herniation remains a matter of debate. By definition, spinal disc herniation (SDH) refers to components of the gelatinous nucleus pulposus protruding beyond the dorsal level of the vertebral body margin through tears in the annulus fibrosus. Clinical presentation may include pain, paresis and sensory disturbances. Magnetic resonance imaging (MRI) is considered the gold standard in the diagnosis of SDH. In the majority of patients a conservative approach with physical therapy exercises and adequate analgesic and antiphlogistic medical treatment results in a substantial improvement of symptoms. (orig.) [German] Degenerative Prozesse eines Bewegungssegments, die in einem Prolaps des Nucleus pulposus resultieren koennen, sind vielschichtig und von unterschiedlicher klinischer und radiologischer Auspraegung. Selbst die Annahme, dass Bandscheibenvorfaellen eine Degeneration vorangeht, ist keineswegs unumstritten. Definitionsgemaess spricht man von einem Bandscheibenvorfall (BSV), wenn das Gewebe des gelatinoesen Nucleus pulposus durch eine Dehiszenz im Anulus fibrosus ueber das Niveau der normalen dorsalen Begrenzung des Bandscheibenfachs hinaus prolabiert. Klinisch kann dies mit Schmerzen, Paresen und Sensibilitaetsstoerungen einhergehen. Die Magnetresonanztomographie gilt als Goldstandard in der Diagnostik eines BSV. In der Mehrzahl der Faelle fuehrt ein konservatives Vorgehen zu einer deutlichen Besserung der Symptomatik im Verlauf. (orig.)

  18. Enhanced motor function by training in spinal cord contused rats following radiation therapy.

    Directory of Open Access Journals (Sweden)

    Ronaldo Ichiyama

    Full Text Available Weight-bearing stepping, without supraspinal re-connectivity, can be attained by treadmill training in an animal whose spinal cord has been completely transected at the lower thoracic level. Repair of damaged tissue and of supraspinal connectivity/circuitry following spinal cord injury in rat can be achieved by specific cell elimination with radiation therapy of the lesion site delivered within a critical time window, 2-3 weeks postinjury. Here we examined the effects of training in the repaired spinal cord following clinical radiation therapy. Studies were performed in a severe rat spinal cord contusion injury model, one similar to fracture/crush injuries in humans; the injury was at the lower thoracic level and the training was a combined hindlimb standing and stepping protocol. Radiotherapy, in a similar manner to that reported previously, resulted in a significant level of tissue repair/preservation at the lesion site. Training in the irradiated group, as determined by limb kinematics tests, resulted in functional improvements that were significant for standing and stepping capacity, and yielded a significant direct correlation between standing and stepping performance. In contrast, the training in the unirradiated group resulted in no apparent beneficial effects, and yielded an inverse correlation between standing and stepping performance, e.g., subject with good standing showed poor stepping capacity. Further, without any training, a differential functional change was observed in the irradiated group; standing capacity was significantly inhibited while stepping showed a slight trend of improvement compared with the unirradiated group. These data suggest that following repair by radiation therapy the spinal circuitries which control posture and locomotor were modified, and that the beneficial functional modulation of these circuitries is use dependent. Further, for restoring beneficial motor function following radiotherapy, training seems

  19. Changes in rat spinal cord gene expression after inflammatory hyperalgesia of the joint and manual therapy.

    Science.gov (United States)

    Ruhlen, Rachel L; Singh, Vineet K; Pazdernik, Vanessa K; Towns, Lex C; Snider, Eric J; Sargentini, Neil J; Degenhardt, Brian F

    2014-10-01

    Mobilization of a joint affects local tissue directly but may also have other effects that are mediated through the central nervous system. To identify differential gene expression in the spinal cords of rats with or without inflammatory joint injury after manual therapy or no treatment. Rats were randomly assigned to 1 of 4 treatment groups: no injury and no touch (NI/NT), injury and no touch (I/NT), no injury and manual therapy (NI/MT), and injury and manual therapy (I/MT). We induced acute inflammatory joint injury in the rats by injecting carrageenan into an ankle. Rats in the no-injury groups did not receive carrageenan injection. One day after injury, rats received manual therapy to the knee of the injured limb. Rats in the no-touch groups were anesthetized without receiving manual therapy. Spinal cords were harvested 30 minutes after therapy or no touch, and spinal cord gene expression was analyzed by microarray for 3 comparisons: NI/NT vs I/NT, I/MT vs I/NT, and NI/NT vs NI/MT. Three rats were assigned to each group. Of 38,875 expressed sequence tags, 755 were differentially expressed in the NI/NT vs I/NT comparison. For the other comparisons, no expressed sequence tags were differentially expressed. Cluster analysis revealed that the differentially expressed sequence tags were over-represented in several categories, including ion homeostasis (enrichment score, 2.29), transmembrane (enrichment score, 1.55), and disulfide bond (enrichment score, 2.04). An inflammatory injury to the ankle of rats caused differential expression of genes in the spinal cord. Consistent with other studies, genes involved in ion transport were among those affected. However, manual therapy to the knees of injured limbs or to rats without injury did not alter gene expression in the spinal cord. Thus, evidence for central nervous system mediation of manual therapy was not observed. © 2014 The American Osteopathic Association.

  20. Workshop: The Technical Requirements for Image-Guided Therapy (Focus: Spinal Cord and Spinal Column)

    Science.gov (United States)

    2000-02-01

    interventions. 7.4 RESEARCH PRIORITIES Although bone morphogenetic proteins (BMPs) and gene therapy will become more and more important in treating...34 dinosaur " and will become obsolete. He believes that better methods to enhance light and magnification need to be developed and implemented, including the

  1. Treatment outcome of radiation therapy and concurrent targeted molecular therapy in spinal metastasis from renal cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sang Joon; Kim, Kyung Hwan; Rhee, Woo Joong; Lee, Jeong Shin; Cho, Yeo Na; Koom, Woong Sub [Dept. of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-06-15

    To evaluate the clinical outcomes of patients who underwent radiation therapy with or without targeted molecular therapy for the treatment of spinal metastasis from renal cell carcinoma (RCC). A total of 28 spinal metastatic lesions from RCC patients treated with radiotherapy between June 2009 and June 2015 were retrospectively reviewed. Thirteen lesions were treated concurrently with targeted molecular therapy (concurrent group) and 15 lesions were not (nonconcurrent group). Local control was defined as lack of radiographically evident local progression and neurological deterioration. At a median follow-up of 11 months (range, 2 to 58 months), the 1-year local progression-free rate (LPFR) was 67.0%. The patients with concurrent targeted molecular therapy showed significantly higher LPFR than those without (p = 0.019). After multivariate analysis, use of concurrent targeted molecular therapy showed a tendency towards improved LPFR (hazard ratio, 0.13; 95% confidence interval, 0.01 to 1.16). There was no difference in the incidence of systemic progression between concurrent and nonconcurrent groups. No grade ≥2 toxicities were observed during or after radiotherapy. Our study suggests the possibility that concurrent use of targeted molecular therapy during radiotherapy may improve LPFR. Further study with a large population is required to confirm these results.

  2. Treatment outcome of radiation therapy and concurrent targeted molecular therapy in spinal metastasis from renal cell carcinoma

    International Nuclear Information System (INIS)

    Park, Sang Joon; Kim, Kyung Hwan; Rhee, Woo Joong; Lee, Jeong Shin; Cho, Yeo Na; Koom, Woong Sub

    2016-01-01

    To evaluate the clinical outcomes of patients who underwent radiation therapy with or without targeted molecular therapy for the treatment of spinal metastasis from renal cell carcinoma (RCC). A total of 28 spinal metastatic lesions from RCC patients treated with radiotherapy between June 2009 and June 2015 were retrospectively reviewed. Thirteen lesions were treated concurrently with targeted molecular therapy (concurrent group) and 15 lesions were not (nonconcurrent group). Local control was defined as lack of radiographically evident local progression and neurological deterioration. At a median follow-up of 11 months (range, 2 to 58 months), the 1-year local progression-free rate (LPFR) was 67.0%. The patients with concurrent targeted molecular therapy showed significantly higher LPFR than those without (p = 0.019). After multivariate analysis, use of concurrent targeted molecular therapy showed a tendency towards improved LPFR (hazard ratio, 0.13; 95% confidence interval, 0.01 to 1.16). There was no difference in the incidence of systemic progression between concurrent and nonconcurrent groups. No grade ≥2 toxicities were observed during or after radiotherapy. Our study suggests the possibility that concurrent use of targeted molecular therapy during radiotherapy may improve LPFR. Further study with a large population is required to confirm these results

  3. The use of complementary and alternative therapies for chronic pain following spinal cord injury: a pilot survey.

    Science.gov (United States)

    Nayak, S; Matheis, R J; Agostinelli, S; Shifleft, S C

    2001-01-01

    The purpose of this study was to determine the patterns and reasons for the use of complementary and alternative medicine (CAM) as a treatment for chronic pain among individuals with spinal cord injuries (SCI). Telephone surveys were conducted in a sample of 77 people with SCI and chronic pain. Of those surveyed, 40.3% had used at least one CAM technique to manage chronic pain. The most common reason was dissatisfaction with conventional medicine. Acupuncture was the most frequently used modality, followed by massage, chiropractic manipulation, and herbal medicine. Acupuncture was rated lowest for satisfaction with pain relief, and massage was rated highest. Individuals not using conventional pain medication or who desired greater control over their health care practices tended to use more CAM techniques than others. Income, insurance coverage, and duration of pain were related to use of CAM. In general, CAM methods were effective for some and totally ineffective for others, indicating selective utility in this population. Despite this small opportunistic sample, the prevalence of CAM among individuals with SCI appears similar to that in the general population. A placebo-controlled trial is needed to evaluate the efficacy of various therapies in the SCI population. The fact that the most effective therapy, massage, was not frequently used suggests the need for more awareness of and research into this technique.

  4. Loss of Efficacy to Spinal Cord Stimulator Therapy: Clinical Evidence and Possible Causes.

    Science.gov (United States)

    Aiudi, Christopher M; Dunn, Roger Y; Burns, Sara M; Roth, Sarah A; Opalacz, Arissa; Zhang, Yi; Chen, Lucy; Mao, Jianren; Ahmed, Shihab U

    2017-11-01

    Although spinal cord stimulation (SCS) therapy has been shown to be efficacious in various pain conditions, the ability for SCS therapy to maintain long-term efficacy has been questioned. The purpose of this study was to investigate whether a loss of efficacy (LOE) phenomenon exists with SCS therapy and to investigate if this phenomenon is more apparent in any specific patient population. A retrospective, observation chart review was conducted to evaluate the patient response to SCS therapy over time. Massachusetts General Hospital, Boston, Massachusetts. Patients who received a SCS at the Massachusetts General Hospital, between January 1, 2002 and December 31, 2012, were invited to participate. A total of 62 patients were included in this study. Various models were created to analyze pain score changes over time using 2-tailed statistical analysis. Additionally, one-way ANOVA and Pearson's chi-square tests were used to determine if certain patient characteristics were associated with LOE. Compared to the visual analog scale (VAS) score at one month after device implantation, pain scores increased 1.95 points after 2 years (95% CI: 1.06 to 2.84, P = patient characteristic that helped predict LOE. However, patients who have significant baseline response to therapy may be more likely to experience LOE. Spinal cord stimulation, chronic pain, retrospective study, low frequency electrical stimulation, efficacy, chronic pain therapy.

  5. Structure-function Evaluation of Stem Cell Therapies for Spinal Cord Injury.

    Science.gov (United States)

    Zhang, Fuguo

    2018-02-23

    Spinal cord injuries (SCI) are prevalent, devastating for quality and expectancy of life, and cause heavy economic burdens. Stem cell therapies hold promise in complete structural and functional restoration of SCI. This review focuses on the methods currently used to evaluate the stem cell therapies for SCI. Various kinds of stem cells involving embryonic stem cells (ESCs), bone marrow stromal cells (BMSCs), neural stem cells (NSCs) and induced pluripotent stem cells (iPSCs) are extensively used in regenerative research of SCI. For evaluation, the survival and integration of transplanted cells, spinal cord reconstruction and functional recovery all should be considered. Histological and histochemistrical, microscopic, and colorimetric assays, and real-time RT-PCR techniques are applied to determine the outcome. From the three main aspects-transplanted cells, spinal cord structure, and functional recovery-we summarize and discuss these methods with certain instances of applications in SCI models. Importantly, for the evaluations of function, neuronal transmitting, electrophysiological analysis and behavioral score are included. Wider conjunction of established technologies, as well as the further development of nondestructive methods might make a big difference in testing stem cell therapies. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  6. Poetry and narrative therapy for anxiety about spinal surgery | Naidu ...

    African Journals Online (AJOL)

    This case study presents the use of poetry in psychotherapy with an adolescent girl, Buhle (a pseudonym), who needed surgery to correct a curvature of her spine due to adolescent idiopathic scoliosis. She experienced anxiety which prevented surgeons from doing the procedure. Psychotherapists used narrative therapy to ...

  7. Clinical relevance of "withdrawal therapy" as a form of hormonal manipulation for breast cancer

    Directory of Open Access Journals (Sweden)

    Robertson John FR

    2011-09-01

    Full Text Available Abstract Background It has been shown in in-vitro experiments that "withdrawal" of tamoxifen inhibits growth of tumor cells. However, evidence is scarce when this is extrapolated into clinical context. We report our experience to verify the clinical relevance of "withdrawal therapy". Methods Breast cancer patients since 1998 who fulfilled the following criteria were selected from the departmental database and the case-notes were retrospectively reviewed: (1 estrogen receptor positive, operable primary breast cancer in elderly (age > 70 years, locally advanced or metastatic breast cancer; (2 disease deemed suitable for treatment by hormonal manipulation; (3 disease assessable by UICC criteria; (4 received "withdrawal" from a prior endocrine agent as a form of therapy; (5 on "withdrawal therapy" for ≥ 6 months unless they progressed prior. Results Seventeen patients with median age of 84.3 (53.7-92.5 had "withdrawal therapy" as second to tenth line of treatment following prior endocrine therapy using tamoxifen (n = 10, an aromatase inhibitor (n = 5, megestrol acetate (n = 1 or fulvestrant (n = 1. Ten patients (58.8% had clinical benefit (CB (complete response/partial response/stable disease ≥ 6 months with a median duration of Clinical Benefit (DoCB of 10+ (7-27 months. Two patients remain on "withdrawal therapy" at the time of analysis. Conclusion "Withdrawal therapy" appears to produce sustained CB in a significant proportion of patients. This applies not only to "withdrawal" from tamoxifen, but also from other categories of endocrine agents. "Withdrawal" from endocrine therapy is, therefore, a viable intercalating option between endocrine agents to minimise resistance and provide additional line of therapy. It should be considered as part of the sequencing of endocrine therapy.

  8. Neuromuscular stimulation therapy after incomplete spinal cord injury promotes recovery of interlimb coordination during locomotion

    Science.gov (United States)

    Jung, R.; Belanger, A.; Kanchiku, T.; Fairchild, M.; Abbas, J. J.

    2009-10-01

    The mechanisms underlying the effects of neuromuscular electrical stimulation (NMES) induced repetitive limb movement therapy after incomplete spinal cord injury (iSCI) are unknown. This study establishes the capability of using therapeutic NMES in rodents with iSCI and evaluates its ability to promote recovery of interlimb control during locomotion. Ten adult female Long Evans rats received thoracic spinal contusion injuries (T9; 156 ± 9.52 Kdyne). 7 days post-recovery, 6/10 animals received NMES therapy for 15 min/day for 5 days, via electrodes implanted bilaterally into hip flexors and extensors. Six intact animals served as controls. Motor function was evaluated using the BBB locomotor scale for the first 6 days and on 14th day post-injury. 3D kinematic analysis of treadmill walking was performed on day 14 post-injury. Rodents receiving NMES therapy exhibited improved interlimb coordination in control of the hip joint, which was the specific NMES target. Symmetry indices improved significantly in the therapy group. Additionally, injured rodents receiving therapy more consistently displayed a high percentage of 1:1 coordinated steps, and more consistently achieved proper hindlimb touchdown timing. These results suggest that NMES techniques could provide an effective therapeutic tool for neuromotor treatment following iSCI.

  9. Response of spinal myoclonus to a combination therapy of autogenic training and biofeedback

    Directory of Open Access Journals (Sweden)

    Kempuraj Duraisamy

    2007-10-01

    Full Text Available Abstract Introduction Clinical evidence indicates that certain types of movement disorders are due to psychosomatic factors. Patients with myoclonic movements are usually treated by a variety of therapeutic agents. Autogenic training (AT, a recognized form of psychosomatic therapies, is suitable for certain types of neurological diseases. We describe a patient with myoclonus who failed to respond to conventional medical therapy. His symptoms were exaggerated by psychogenic factors, especially anger. Case presentation A 42-year-old man was admitted to our hospital, Preventive Welfare Clinic, for severe paroxysmal axial myoclonus of the left shoulder and abdominal muscles. The initial diagnosis was "combination of spinal segmental myoclonus and propriospinal myoclonus". The myoclonic movements did not occur during sleep but were aggravated by bathing, alcohol drinking, and anger. Psychological examination indicated hostile attribution. Although considered not to be a case of psychogenic myoclonus, a "psychogenic factor" was definitely involved in the induction of the organic myoclonus. The final diagnosis was "combination of spinal segmental myoclonus and propriospinal myoclonus accompanied by features of psychosomatic disorders". The patient underwent psychosomatic therapy including AT and surface electromyography (EMG-biofeedback therapy and treatment with clonazepam and carbamazepine. Results AT and EMG-biofeedback resulted in shortening the duration and reducing the amplitude and frequency of the myoclonic discharges. Conclusion Psychosomatic therapy with AT and surface EMG-biofeedback produced excellent improvement of myoclonic movements and allowed the reduction of the dosage of conventional medications.

  10. Response of spinal myoclonus to a combination therapy of autogenic training and biofeedback.

    Science.gov (United States)

    Sugimoto, Koreaki; Theoharides, Theoharis C; Kempuraj, Duraisamy; Conti, Pio

    2007-10-12

    Clinical evidence indicates that certain types of movement disorders are due to psychosomatic factors. Patients with myoclonic movements are usually treated by a variety of therapeutic agents. Autogenic training (AT), a recognized form of psychosomatic therapies, is suitable for certain types of neurological diseases. We describe a patient with myoclonus who failed to respond to conventional medical therapy. His symptoms were exaggerated by psychogenic factors, especially anger. A 42-year-old man was admitted to our hospital, Preventive Welfare Clinic, for severe paroxysmal axial myoclonus of the left shoulder and abdominal muscles. The initial diagnosis was "combination of spinal segmental myoclonus and propriospinal myoclonus". The myoclonic movements did not occur during sleep but were aggravated by bathing, alcohol drinking, and anger. Psychological examination indicated hostile attribution. Although considered not to be a case of psychogenic myoclonus, a "psychogenic factor" was definitely involved in the induction of the organic myoclonus. The final diagnosis was "combination of spinal segmental myoclonus and propriospinal myoclonus accompanied by features of psychosomatic disorders". The patient underwent psychosomatic therapy including AT and surface electromyography (EMG)-biofeedback therapy and treatment with clonazepam and carbamazepine. AT and EMG-biofeedback resulted in shortening the duration and reducing the amplitude and frequency of the myoclonic discharges. Psychosomatic therapy with AT and surface EMG-biofeedback produced excellent improvement of myoclonic movements and allowed the reduction of the dosage of conventional medications.

  11. Adverse Outcomes After Palliative Radiation Therapy for Uncomplicated Spine Metastases: Role of Spinal Instability and Single-Fraction Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Lam, Tai-Chung, E-mail: lamtaichung@gmail.com [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, Massachusetts (United States); Uno, Hajime [Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Krishnan, Monica [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, Massachusetts (United States); Lutz, Steven [Department of Radiation Oncology, Blanchard Valley Regional Medical Center, Findlay, Ohio (United States); Groff, Michael [Department of Neurosurgery, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Cheney, Matthew [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Balboni, Tracy [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, Massachusetts (United States); Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts (United States)

    2015-10-01

    Purpose: Level I evidence demonstrates equivalent pain response after single-fraction (SF) or multifraction (MF) radiation therapy (RT) for bone metastases. The purpose of this study is to provide additional data to inform the incidence and predictors of adverse outcomes after RT for spine metastases. Methods and Materials: At a single institution, 299 uncomplicated spine metastases (without cord compression, prior RT, or surgery) treated with RT from 2008 to 2013 were retrospectively reviewed. The spinal instability neoplastic score (SINS) was used to assess spinal instability. The primary outcome was time to first spinal adverse event (SAE) at the site, including symptomatic vertebral fracture, hospitalization for site-related pain, salvage surgery, interventional procedure, new neurologic symptoms, or cord compression. Fine and Gray's multivariable model assessed associations of the primary outcome with SINS, SF RT, and other significant baseline factors. Propensity score matched analysis further assessed the relationship of SF RT to first SAEs. Results: The cumulative incidence of first SAE after SF RT (n=66) was 6.8% at 30 days, 16.9% at 90 days, and 23.6% at 180 days. For MF RT (n=233), the incidence was 3.5%, 6.4%, and 9.2%, respectively. In multivariable analysis, SF RT (hazard ratio [HR] = 2.8, 95% confidence interval [CI] 1.5-5.2, P=.001) and SINS ≥11 (HR=2.5 , 95% CI 1.3-4.9, P=.007) were predictors of the incidence of first SAE. In propensity score matched analysis, first SAEs had developed in 22% of patients with SF RT versus 6% of those with MF RT cases (HR=3.9, 95% CI 1.6-9.6, P=.003) at 90 days after RT. Conclusion: In uncomplicated spinal metastases treated with RT alone, spinal instability with SINS ≥11 and SF RT were associated with a higher rate of SAEs.

  12. Overreaching in coordination dynamics therapy in an athlete with a spinal cord injury.

    Science.gov (United States)

    Schalow, G; Vaher, I; Jaigma, P

    2008-03-01

    A motocross athlete suffered a clinically complete spinal cord injury (SCI) during competition. Although MRIs (magnetic resonance imaging) showed a complete spinal cord injury at the Thoracic 11/12 levels, surface EMG recordings indicated the survival of few tract fibres across the injury site. Six weeks after the accident the subject began intensive Coordination Dynamics Therapy (CDT) at an up-to-date therapy centre. The subject trained at his physical limits to induce structural and functional repair. Exercising at variable loads between 20 and 200N (on a special CDT and recording device) generated periods of overreaching and super-compensation. By plotting coordination dynamics values (kinesiology), including high-load exertion (200N) and hysteresis curves, periods of overreaching and super-compensation were made graphically visible. It was found that symmetrical improvements of central nervous system (CNS) functioning occurred during overreaching. Improvements in spinal cord functioning were achieved throughout one year of CDT in this chronically injured subject with an almost anatomically complete SCI. It is discussed that the measuring of CNS functions by means of recording coordination dynamics is a powerful and non-invasive tool ideal for exact quantitative and qualitative measurements of improvement (or change) in CNS functioning. Such diagnostics may be of particular importance in sport during training and before competition. Also, coordination dynamics might be used to measure the effects of prolonged exposure to reduced gravitational conditions on CNS functions, such as faced by astronauts.

  13. Stem cell therapy in spinal cord injury: Hollow promise or promising science?

    Directory of Open Access Journals (Sweden)

    Aimee Goel

    2016-01-01

    Full Text Available Spinal cord injury (SCI remains one of the most physically, psychologically and socially debilitating conditions worldwide. While rehabilitation measures may help limit disability to some extent, there is no effective primary treatment yet available. The efficacy of stem cells as a primary therapeutic option in spinal cord injury is currently an area under much scrutiny and debate. Several laboratory and some primary clinical studies into the use of bone marrow mesenchymal stem cells or embryonic stem cell-derived oligodentrocyte precursor cells have shown some promising results in terms of remyelination and regeneration of damaged spinal nerve tracts. More recently,laboratory and early clinical experiments into the use of Olfactory Ensheathing Cells, a type of glial cell derived from olfactory bulb and mucosa have provided some phenomenal preliminary evidence as to their neuroregenerative and neural bridging capacity. This report compares and evaluates some current research into selected forms of embryonic and mesenchymal stem cell therapy as well as olfactory ensheathing cell therapy in SCI, and also highlights some legal and ethical issues surrounding their use. While early results shows promise, more rigorous large scaleclinical trials are needed to shed light on the safety, efficacy and long term viability of stem cell and cellular transplant techniques in SCI.

  14. Advantages of soft subdural implants for the delivery of electrochemical neuromodulation therapies to the spinal cord

    Science.gov (United States)

    Capogrosso, Marco; Gandar, Jerome; Greiner, Nathan; Moraud, Eduardo Martin; Wenger, Nikolaus; Shkorbatova, Polina; Musienko, Pavel; Minev, Ivan; Lacour, Stephanie; Courtine, Grégoire

    2018-04-01

    opportunity to deliver electrical and chemical neuromodulation therapies using a single, bio-compatible and mechanically compliant device that effectively alleviates locomotor deficits after spinal cord injury.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. A Brief Analysis of Traditional Chinese Medical Elongated Needle Therapy on Acute Spinal Cord Injury and Its Mechanism

    Directory of Open Access Journals (Sweden)

    Mengxuan Du

    2013-01-01

    Full Text Available Acute spinal cord injury is one of the most common and complicated diseases among human spinal injury. We aimed to explore the effect of point-through-point acupuncture therapy with elongated needles on acute spinal cord injury in rabbits and its possible mechanism. Adult rabbits were randomly divided into a model group, elongated needle therapy group, and blank group. Immunohistochemical staining showed that the protein levels of Fas and caspase-3 in the model group were significantly higher than those in the blank group at each time point (P<0.05 and significantly lower than those in the elongated needle therapy group on the 3rd and 5th days after operation (P<0.05. RT-PCR showed that Fas and caspase-3 mRNA levels in the model group and elongated needle therapy group were significantly higher than those in the blank group (P<0.05, 0.01. The mRNA levels of Fas and caspase-3 in the elongated needle therapy group were significantly lower than those in model group on the 3rd day (P<0.05, 0.01. Therefore, we confirmed that elongated needle therapy has an obvious effect on acute spinal cord injury in rabbits. Its mechanism is made possible by inhibiting the expression of the Fas→caspase-3 cascade, thereby inhibiting cell apoptosis after spinal cord injury.

  17. Early and delayed results of radiotherapy and multimodality therapy of spinal hemangiomas

    International Nuclear Information System (INIS)

    Morozov, A.I.; Neretin, V.Ya.; Korshunov, A.I.; Nikolaeva, S.N.; Balkanov, A.S.; Marchenko, V.A.

    1988-01-01

    The authors described the results of therapy of 74 spinal hemangioma patients. The patients were divided into 2 groups: 1 - radiotherapy only; 2 - radiotherapy following surgical intervention for enhanced symptoms of spinal compression. γ-beam therapy was given 5 times a week at a single dose of 0.8-1.2 Gy. An integral dose delivered to the cervical spine was 26-32 Gy, to the thoracic spine 28-30 Gy, to the lumber spine - 30-34 Gy. Field sizes varied from 3x4 to 3x12 cm depending on lesion spreading. Therapy also included traction on a special platform bed. An analysis of delayed therapeutic results (from 3 to 13 yrs.) has shown that clinical convalescence with regained working capacity in the 1st group (40 patients) was observed in 21 patients, in the 2nd group (34 patients) - in 5 patients only. Partial functional restoration was observed in both groups (19 patients in each group). The therapy applied was ineffective in 10 patients of the 2nd group

  18. Deep postoperative spine infection treated by negative pressure therapy in patients with progressive spinal deformities.

    Science.gov (United States)

    Canavese, Federico; Marengo, Lorenza; Corradin, Marco; Mansour, Mounira; Samba, Antoine; Andreacchio, Antonio; Rousset, Marie; Dimeglio, Alain

    2018-04-01

    The aim of the study is to review the outcome of using the VAC system in children and adolescents who have developed postoperative spinal infection after posterior instrumented spinal fusion, and to evaluate whether this technique is also feasible in patients treated with posterior instrumented fusion with polyester sublaminar bands. A total of 11 out of 118 consecutive children and adolescents (5 males) with deep postoperative spinal infection were identified; infections were categorised as early (acute), delayed (subacute) or late (chronic) according to time of onset. Irrespective of the etiology and the onset, all the deep infections were managed with the reported technique. All the patients had regular clinical and radiological follow-up. Eight out of 11 patients developed an early (72.7%), 2 a delayed (18.2%) and 1 a late deep postoperative infection (9.1%); 7 out of 11 (63.6%) showed severe mental compromise. No statistically significant differences were observed for mean number of VAC dressing changes (p = 0.81) and mean length of hospitalisation comparing patients with early infection versus patients with delayed or late infections (p = 0.32). Mean number of VAC dressing changes (p = 0.02) and mean number of hospitalisation days (p = 0.05) were higher in patients with underlying neurological disorders than in those without, while mean length of hospitalisation was longer in neuromuscular patients. The application of the VAC system, as an adjunct to surgical debridement and adequate antibiotic therapy, is a reliable method for the treatment of postoperative infection in children and adolescents undergoing spinal instrumentation and fusion. It can reduce the need for further complex soft-tissue procedure, removal of hardware with consequent loss of correction, and pseudoarthrosis. Finally, the use of VAC therapy is not contraindicated in patients treated with hybrid constructs with sublaminar bands. III.

  19. Biophotonic techniques for manipulation and characterization of drug delivery nanosystems in cancer therapy.

    Science.gov (United States)

    Spyratou, E; Makropoulou, M; Mourelatou, E A; Demetzos, C

    2012-12-31

    Reactive oxygen species (ROS) are usually involved in two opposite procedures related to cancer: initiation, progression and metastasis of cancer, as well as in all non-surgical therapeutic approaches for cancer, including chemotherapy, radiotherapy and photodynamic therapy. This review is concentrated in new therapeutic strategies that take advantage of increased ROS in cancer cells to enhance therapeutic activity and selectivity. Novel biophotonic techniques for manipulation and characterization of drug delivery nanosystems in cancer therapy are discussed, including optical tweezers and atomic force microscopy. This review highlights how these techniques are playing a critical role in recent and future cancer fighting applications. We can conclude that Biophotonics and nanomedicine are the future for cancer biology and disease management, possessing unique potential for early detection, accurate diagnosis, dosimetry and personalized treatment of biomedical applications targeting cancer. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  20. A case of recurrent breast cancer with intramedullary spinal cord metastasis and symptomatic improvement by Radiation Therapy

    International Nuclear Information System (INIS)

    Wakahara, Makoto; Hosoya, Keiko; Hirooka, Yumi

    2017-01-01

    A 65-year-old woman underwent surgery for right breast cancer (TIN1aM0) in December 2005. In March 2011, the breast cancer recurred with multiple lung and lymph node metastases. In February 2013, because of multiple brain metastases whole-brain radiation therapy was performed. In January 2014, she developed paralysis of the left leg. Spinal cord magnetic resonance imaging revealed a mass lesion (Th12 to L1 level) in the spinal cord, and she was diagnosed with intramedullary spinal cord metastasis (ISCM) from the breast cancer. Spinal cord irradiation reduced the metastasis and improved her paralysis. Although pharmacotherapy was continued, her metastases, with the exception of ISCM, progressed and she died of the disease in November 2014. It is necessary to diagnose ISCM at the time of its onset. Additionally immediate therapeutic intervention can significantly reduce the volume of ISCM, resulting in symptomatic relief from neurological deficit; in this case, radiation therapy was effective. (author)

  1. Clinical applicability of biologically effective dose calculation for spinal cord in fractionated spine stereotactic body radiation therapy

    International Nuclear Information System (INIS)

    Lee, Seung Heon; Lee, Kyu Chan; Choi, Jinho; Ahn, So Hyun; Lee, Seok Ho; Sung, Ki Hoon; Kil, Se Hee

    2015-01-01

    The aim of the study was to investigate whether biologically effective dose (BED) based on linear-quadratic model can be used to estimate spinal cord tolerance dose in spine stereotactic body radiation therapy (SBRT) delivered in 4 or more fractions. Sixty-three metastatic spinal lesions in 47 patients were retrospectively evaluated. The most frequently prescribed dose was 36 Gy in 4 fractions. In planning, we tried to limit the maximum dose to the spinal cord or cauda equina less than 50% of prescription or 45 Gy 2/2 . BED was calculated using maximum point dose of spinal cord. Maximum spinal cord dose per fraction ranged from 2.6 to 6.0 Gy (median 4.3 Gy). Except 4 patients with 52.7, 56.4, 62.4, and 67.9 Gy 2/2 , equivalent total dose in 2-Gy fraction of the patients was not more than 50 Gy 2/2 (12.1–67.9, median 32.0). The ratio of maximum spinal cord dose to prescription dose increased up to 82.2% of prescription dose as epidural spinal cord compression grade increased. No patient developed grade 2 or higher radiation-induced spinal cord toxicity during follow-up period of 0.5 to 53.9 months. In fractionated spine SBRT, BED can be used to estimate spinal cord tolerance dose, provided that the dose per fraction to the spinal cord is moderate, e.g. < 6.0 Gy. It appears that a maximum dose of up to 45–50 Gy 2/2 to the spinal cord is tolerable in 4 or more fractionation regimen

  2. Thrust joint manipulation curricula in first-professional physical therapy education: 2012 update.

    Science.gov (United States)

    Noteboom, J Timothy; Little, Christian; Boissonnault, William

    2015-06-01

    Descriptive online observational survey. To identify the extent of thrust joint manipulation (TJM) integration into first-professional physical therapy program curricula. The most recent survey of TJM curricula was published in 2004, with a wide variation in faculty responses noted. Since that time, faculty resources have been developed and TJM language in "A Normative Model of Physical Therapist Professional Education" from the American Physical Therapy Association has been updated, leaving the current status of TJM education in curricula unknown. Faculty from 205 accredited physical therapy programs were invited to participate in an anonymous 35-item electronic survey during the summer of 2012. Seventy-two percent of programs responded to the survey, with 99% of programs teaching TJM and 97% of faculty believing TJM to be an entry-level skill. Cervical spine TJM is still being taught at a lower rate than techniques for other body regions. Faculty deemed 91% and 77% of students, respectively, at or above entry-level competency for implementing TJM in their clinical practice upon graduation. Most respondents indicated that increased utilization of TJM during clinical affiliations (78%) and lab hours (78%) would be beneficial to the student's knowledge/application of TJM. The utilization of TJM and faculty perceptions in first-professional physical therapy programs in the United States have evolved over the past decade. With TJM content more fully integrated into educational curricula, programs can now look to refine teaching strategies that enhance learning outcomes.

  3. Cervical spinal epidural abscess following acupuncture and wet-cupping therapy: A case report.

    Science.gov (United States)

    Yao, Yindan; Hong, Wenke; Chen, Huimin; Guan, Qiongfeng; Yu, Hu; Chang, Xianchao; Yu, Yaoping; Xu, Shanhu; Fan, Weinv

    2016-02-01

    Report of an uncommon complication of acupuncture and wet cupping. A 54-year-old man presented with neck pain and fever. Magnetic resonance imaging of the cervical spine revealed an epidural abscess at C4 to T2. The symptoms related to epidural abscess resolved partially after treatment with antibiotics. Acupuncture and wet-cupping therapy should be taken into consideration as a cause of spinal epidural abscesses in patients who present with neck pain and fever. Furthermore, acupuncture and wet-cupping practitioners should pay attention to hygienic measures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Biomaterials combined with cell therapy for treatment of spinal cord injury

    Czech Academy of Sciences Publication Activity Database

    Kubinová, Šárka; Syková, Eva

    2012-01-01

    Roč. 7, č. 2 (2012), s. 207-224 ISSN 1746-0751 R&D Projects: GA ČR(CZ) GAP108/10/1560; GA ČR(CZ) GAP304/11/0731; GA ČR(CZ) GAP304/11/0653; GA AV ČR(CZ) IAA500390902; GA AV ČR(CZ) KAN200520804; GA MŠk 1M0538 Institutional research plan: CEZ:AV0Z50390512; CEZ:AV0Z50390703 Institutional support: RVO:68378041 Keywords : biomaterial cell therapy * scaffold * spinal cord injury Subject RIV: FH - Neurology Impact factor: 3.873, year: 2012

  5. Large animal and primate models of spinal cord injury for the testing of novel therapies.

    Science.gov (United States)

    Kwon, Brian K; Streijger, Femke; Hill, Caitlin E; Anderson, Aileen J; Bacon, Mark; Beattie, Michael S; Blesch, Armin; Bradbury, Elizabeth J; Brown, Arthur; Bresnahan, Jacqueline C; Case, Casey C; Colburn, Raymond W; David, Samuel; Fawcett, James W; Ferguson, Adam R; Fischer, Itzhak; Floyd, Candace L; Gensel, John C; Houle, John D; Jakeman, Lyn B; Jeffery, Nick D; Jones, Linda Ann Truett; Kleitman, Naomi; Kocsis, Jeffery; Lu, Paul; Magnuson, David S K; Marsala, Martin; Moore, Simon W; Mothe, Andrea J; Oudega, Martin; Plant, Giles W; Rabchevsky, Alexander Sasha; Schwab, Jan M; Silver, Jerry; Steward, Oswald; Xu, Xiao-Ming; Guest, James D; Tetzlaff, Wolfram

    2015-07-01

    Large animal and primate models of spinal cord injury (SCI) are being increasingly utilized for the testing of novel therapies. While these represent intermediary animal species between rodents and humans and offer the opportunity to pose unique research questions prior to clinical trials, the role that such large animal and primate models should play in the translational pipeline is unclear. In this initiative we engaged members of the SCI research community in a questionnaire and round-table focus group discussion around the use of such models. Forty-one SCI researchers from academia, industry, and granting agencies were asked to complete a questionnaire about their opinion regarding the use of large animal and primate models in the context of testing novel therapeutics. The questions centered around how large animal and primate models of SCI would be best utilized in the spectrum of preclinical testing, and how much testing in rodent models was warranted before employing these models. Further questions were posed at a focus group meeting attended by the respondents. The group generally felt that large animal and primate models of SCI serve a potentially useful role in the translational pipeline for novel therapies, and that the rational use of these models would depend on the type of therapy and specific research question being addressed. While testing within these models should not be mandatory, the detection of beneficial effects using these models lends additional support for translating a therapy to humans. These models provides an opportunity to evaluate and refine surgical procedures prior to use in humans, and safety and bio-distribution in a spinal cord more similar in size and anatomy to that of humans. Our results reveal that while many feel that these models are valuable in the testing of novel therapies, important questions remain unanswered about how they should be used and how data derived from them should be interpreted. Copyright © 2015 Elsevier

  6. Non-surgical spinal decompression therapy: does the scientific literature support efficacy claims made in the advertising media?

    Directory of Open Access Journals (Sweden)

    Daniel Dwain M

    2007-05-01

    Full Text Available Abstract Background Traction therapy has been utilized in the treatment of low back pain for decades. The most recent incarnation of traction therapy is non-surgical spinal decompression therapy which can cost over $100,000. This form of therapy has been heavily marketed to manual therapy professions and subsequently to the consumer. The purpose of this paper is to initiate a debate pertaining to the relationship between marketing claims and the scientific literature on non-surgical spinal decompression. Discussion Only one small randomized controlled trial and several lower level efficacy studies have been performed on spinal decompression therapy. In general the quality of these studies is questionable. Many of the studies were performed using the VAX-D® unit which places the patient in a prone position. Often companies utilize this research for their marketing although their units place the patient in the supine position. Summary Only limited evidence is available to warrant the routine use of non-surgical spinal decompression, particularly when many other well investigated, less expensive alternatives are available.

  7. Can Constraint Induced Movement Therapy Improve In-Hand Manipulation Skills: A Single Subject Design

    Directory of Open Access Journals (Sweden)

    Somaye Kavousipor

    2012-04-01

    Full Text Available Objectives: This study describes a single subject design (ABA that shows the effective use of constraint induced movement therapy in improvement of quality and performance of in-hand manipulation skills for a 10 year old boy and a 9 years old girl with hemiplegic cerebral palsy, as Dickerson (2007 showed it in arm movement and function. Methods: To determine the effectiveness of CIMT by the use of C-statistic analysis and visual analysis. Approach: The first step was to design a child friendly group activity and home based intervention program through occupation. The possible effectiveness of CIMT was evaluated by daily measurements and video recording of 6 sub skills of in-hand manipulation according to Pont category (2009 in defined activity. Results: For making the treatment more cost effective, families can produce a simple clinical setting at home and participate in their child treatment plan actively. Discussion: A client center intervention will facilitate the use and quality of fingers and hand motion. Also a group activity can motivate participants to participate more and better.

  8. A Medical Manipulator System with Lasers in Photodynamic Therapy of Port Wine Stains

    Directory of Open Access Journals (Sweden)

    Xingtao Wang

    2014-01-01

    Full Text Available Port wine stains (PWS are a congenital malformation and dilation of the superficial dermal capillary. Photodynamic therapy (PDT with lasers is an effective treatment of PWS with good results. However, because the laser density is uneven and nonuniform, the treatment is carried out manually by a doctor thus providing little accuracy. Additionally, since the treatment of a single lesion can take between 30 and 60 minutes, the doctor can become fatigued after only a few applications. To assist the medical staff with this treatment method, a medical manipulator system (MMS was built to operate the lasers. The manipulator holds the laser fiber and, using a combination of active and passive joints, the fiber can be operated automatically. In addition to the control input from the doctor over a human-computer interface, information from a binocular vision system is used to guide and supervise the operation. Clinical results are compared in nonparametric values between treatments with and without the use of the MMS. The MMS, which can significantly reduce the workload of doctors and improve the uniformity of laser irradiation, was safely and helpfully applied in PDT treatment of PWS with good therapeutic results.

  9. Therapy induces widespread reorganization of motor cortex after complete spinal transection that supports motor recovery.

    Science.gov (United States)

    Ganzer, Patrick D; Manohar, Anitha; Shumsky, Jed S; Moxon, Karen A

    2016-05-01

    Reorganization of the somatosensory system and its relationship to functional recovery after spinal cord injury (SCI) has been well studied. However, little is known about the impact of SCI on organization of the motor system. Recent studies suggest that step-training paradigms in combination with spinal stimulation, either electrically or through pharmacology, are more effective than step training alone at inducing recovery and that reorganization of descending corticospinal circuits is necessary. However, simpler, passive exercise combined with pharmacotherapy has also shown functional improvement after SCI and reorganization of, at least, the sensory cortex. In this study we assessed the effect of passive exercise and serotonergic (5-HT) pharmacological therapies on behavioral recovery and organization of the motor cortex. We compared the effects of passive hindlimb bike exercise to bike exercise combined with daily injections of 5-HT agonists in a rat model of complete mid-thoracic transection. 5-HT pharmacotherapy combined with bike exercise allowed the animals to achieve unassisted weight support in the open field. This combination of therapies also produced extensive expansion of the axial trunk motor cortex into the deafferented hindlimb motor cortex and, surprisingly, reorganization within the caudal and even the rostral forelimb motor cortex areas. The extent of the axial trunk expansion was correlated to improvement in behavioral recovery of hindlimbs during open field locomotion, including weight support. From a translational perspective, these data suggest a rationale for developing and optimizing cost-effective, non-invasive, pharmacological and passive exercise regimes to promote plasticity that supports restoration of movement after spinal cord injury. Copyright © 2016. Published by Elsevier Inc.

  10. Stem cell therapy in spinal trauma: Does it have scientific validity?

    Directory of Open Access Journals (Sweden)

    Harvinder Singh Chhabra

    2015-01-01

    Full Text Available Stem cell-based interventions aim to use special regenerative cells (stem cells to facilitate neuronal function beyond the site of the injury. Many studies involving animal models of spinal cord injury (SCI suggest that certain stem cell-based therapies may restore function after SCI. Currently, in case of spinal cord injuries, new discoveries with clinical implications have been continuously made in basic stem cell research, and stem cell-based approaches are advancing rapidly toward application in patients. There is a huge base of preclinical evidence in vitro and in animal models which suggests the safety and clinical efficacy of cellular therapies after SCI. Despite this, data from clinical studies is not very encouraging and at times confounding. Here, we have attempted to cover preclinical and clinical evidence base dealing with safety, feasibility and efficacy of cell based interventions after SCI. The limitations of preclinical data and the reasons underlying its failure to translate in a clinical setting are also discussed. Based on the evidence base, it is suggested that a multifactorial approach is required to address this situation. Need for standardized, stringently designed multi-centric clinical trials for obtaining validated proof of evidence is also highlighted.

  11. Pilot trial of osteopathic manipulative therapy for patients with frequent episodic tension-type headache.

    Science.gov (United States)

    Rolle, Guido; Tremolizzo, Lucio; Somalvico, Francesco; Ferrarese, Carlo; Bressan, Livio C

    2014-09-01

    Osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) may be used for managing headache pain and related disability, but there is a need for high-quality randomized controlled trials to assess the effectiveness of this intervention. To explore the efficacy of OMTh for pain management in frequent episodic tension-type headache (TTH). Single-blind randomized placebo-controlled pilot study. Patients were recruited from 5 primary care settings. Forty-four patients who were affected by frequent episodic TTH and not taking any drugs for prophylactic management of episodic TTH were recruited. Patients were randomly allocated to an experimental or control group. The experimental group received corrective OMTh techniques, tailored for each patient; the control group received assessment of the cranial rhythmic impulse (sham therapy). The study included a 1-month baseline period, a 1-month treatment period, and a 3-month follow-up period. The primary outcome was the change in patient-reported headache frequency, and secondary outcomes included changes in headache pain intensity (discrete score, 1 [lowest perceived pain] to 5 [worst perceived pain]), over-the-counter medication use, and Headache Disability Inventory score. Forty patients completed the study (OMTh, n=21; control, n=19). The OMTh group had a significant reduction in headache frequency over time that persisted 1 month (approximate reduction, 40%; Ptreatment. Moreover, there was an absolute difference between the 2 treatment groups at the end of the study, with a 33% lower frequency of headache in the OMTh group (Ptreatment modalities and may benefit patients who have adverse effects to medications or who have difficulty complying with pharmacologic regimens. This protocol may serve as a model for future studies. © 2014 The American Osteopathic Association.

  12. Protective effect of bone marrow mesenchymal stem cells combined with erythropoietin therapy on spinal cord injury rat model

    Directory of Open Access Journals (Sweden)

    Peng Xie

    2016-01-01

    Full Text Available Objective: To study the protective effect of bone marrow mesenchymal stem cells combined with erythropoietin therapy on spinal cord injury rat model. Methods: SD rats were selected as experimental animals, spinal cord injury rat model was built by striking spinal cord with Hatteras Instruments PCI3000, and model rats were divided into control group, bone marrow mesenchymal stem cells (BMSCs group, erythropoietin (EPO group and BMSCs combined with EPO group according to different treatment methods. Then number of apoptotic cells in spinal cord tissue, contents of neural markers and neurotrophic factors as well as expression of apoptosis and injury molecules was detected. Results: Number of apoptotic cells as well as mRNA contents of Caspase-3 and c-fos of BMSCs group, EPO group and BMSCs+EPO group was lower than those of control group, and number of apoptotic cells as well as mRNA contents of Caspase-3 and c-fos of BMSCs+EPO group were lower than those of BMSCs group and EPO group; mRNA contents of NF-200 and MBP as well as protein contents of NGF and BDNF in spinal cord tissue of BMSCs group, EPO group and BMSCs+EPO group were higher than those of control group, and mRNA contents of NF-200 and MBP as well as protein contents of NGF and BDNF in spinal cord tissue of BMSCs+EPO group were higher than those of BMSCs group and EPO group. Conclusions: Bone marrow mesenchymal stem cells combined with erythropoietin therapy can inhibit cell apoptosis in the injured spinal cord tissue, increase neurotrophic factor levels and inhibit apoptosis and injury molecule expression; it has protective effect on spinal cord injury.

  13. The effect of manipulation plus massage therapy versus massage therapy alone in people with tension-type headache. A randomized controlled clinical trial.

    Science.gov (United States)

    Espí-López, Gemma V; Zurriaga-Llorens, Rosario; Monzani, Lucas; Falla, Deborah

    2016-10-01

    Manipulative techniques have shown promising results for relief of tension-type headache (TTH), however prior studies either lacked a control group, or suffered from poor methodological quality. The aim of this study was to compare the effect of spinal manipulation combined with massage versus massage alone on range of motion of the cervical spine, headache frequency, intensity and disability in patients with TTH. Randomized, single-blinded, controlled clinical trial. University clinic. We enrolled 105 subjects with TTH. Participants were divided into two groups: 1) manipulation and massage; 2) massage only (control). Four treatment sessions were applied over four weeks. The Headache Disability Inventory (HDI) and range of upper cervical and cervical motion were evaluated at baseline, immediately after the intervention and at a follow-up, 8 weeks after completing the intervention. Both groups demonstrated a large (ƒ=1.22) improvement on their HDI scores. Those that received manipulation reported a medium-sized reduction (ƒ=0.33) in headache frequency across all data points (Pheadache. Although massage provided relief of headache in TTH sufferers, when combined with cervical manipulation, there was a stronger effect on range of upper cervical spine motion.

  14. Proton Therapy for Spinal Ependymomas: Planning, Acute Toxicities, and Preliminary Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Amsbaugh, Mark J. [Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Grosshans, David R., E-mail: dgrossha@mdanderson.org [Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); McAleer, Mary Frances; Zhu, Ron; Wages, Cody; Crawford, Cody N.; Palmer, Matthew; De Gracia, Beth; Woo Shiao; Mahajan, Anita [Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States)

    2012-08-01

    Purpose: To report acute toxicities and preliminary outcomes for pediatric patients with ependymomas of the spine treated with proton beam therapy at the MD Anderson Cancer Center. Methods and Materials: Eight pediatric patients received proton beam irradiation between October 2006 and September 2010 for spinal ependymomas. Toxicity data were collected weekly during radiation therapy and all follow-up visits. Toxicities were graded according to the Common Terminology Criteria for Adverse Events version 3.0. Results: All patients had surgical resection of the tumor before irradiation (7 subtotal resection and 1 gross total resection). Six patients had World Health Organization Grade I ependymomas, and two had World Health Organization Grade II ependymomas. Patients had up to 3 surgical interventions before radiation therapy (range, 1-3; median, 1). Three patients received proton therapy after recurrence and five as part of their primary management. The entire vertebral body was treated in all but 2 patients. The mean radiation dose was 51.1 cobalt gray equivalents (range, 45 to 54 cobalt gray equivalents). With a mean follow-up of 26 months from the radiation therapy start date (range, 7-51 months), local control, event-free survival, and overall survival rates were all 100%. The most common toxicities during treatment were Grade 1 or 2 erythema (75%) and Grade 1 fatigue (38%). No patients had a Grade 3 or higher adverse event. Proton therapy dramatically reduced dose to all normal tissues anterior to the vertebral bodies in comparison to photon therapy. Conclusion: Preliminary outcomes show the expected control rates with favorable acute toxicity profiles. Proton beam therapy offers a powerful treatment option in the pediatric population, where adverse events related to radiation exposure are of concern. Extended follow-up will be required to assess for late recurrences and long-term adverse effects.

  15. [Randomized controlled trials of needle knife therapy combined with rotation traction manipulation for the treatment of cervical spondylotic radiculopathy].

    Science.gov (United States)

    Zhou, Zhong-Liang; Su, Guo-Hong; Zheng, Bao-Zhu; Zuo, Yu-Zhu; Wei, Fu-Liang

    2016-09-25

    To compare the therapeutic effects between needle knife therapy combined with rotation traction manipulation and rotation traction manipulation for the treatment of cervical spondylotic radiculopathy. From November 2013 to June 2015, 80 patients with cervical spondylotic radiculopathy meeting the inclusion criteria were divided into two groups randomly:the control group in which 39 patients were treated with rotation traction manipulation, and the treatment group in which 41 patients were treated with needle knife combined with rotation traction manipulation. The patients in the control group were treated once dayly for 2 weeks, which was 1 course. The patients in the treatment group were treated with needle knife firstly once a week for 2 weeks, which was 1 course;then were treated with the same methods as the patients in the control group. The symptoms, signs score and the therapeutic effects of the two groups before and after treatment were observed. After treatment, symptoms and signs scores declined in both groups( P knife combined with rotation traction manipulation is an effective method for the treatment of cervical spondylotic radiculopathy, which is better than using manipulation method simply. Needle knife therapy has follow advantages:improving local blood circulation, reducing local content of pain substance, increasing production of substances resisting pain, opening channels and collaterals, and make body reaching new static and dynamic balance on the new foundation.

  16. SYSTEMATIC REVIEW OF RECOVERY OF SPINAL CORD INJURY WITH ANTIOXIDANT THERAPY

    Directory of Open Access Journals (Sweden)

    MARCO ANTONIO EDUARDO KOFF

    Full Text Available ABSTRACT The objective of the paper is to analyze the frequency and efficacy of experimental studies with antioxidant therapy. A search was conducted in the pubmed.gov database using the keywords "antioxidants" AND "spinal cord injury", from January 2000 to December 2015, resulting in 686 articles. Studies of non-traumatic injuries, non-antioxidant therapies, absence of neurological and functional evaluation, and non-experimental studies were excluded, leaving a total of 43 articles. The most used therapies were melatonin (16.2%, quercetin (9.3%, epigallocatechin and edaravone (6.9%. The most frequent route of administration was intraperitoneal (72.09%. The dose and mode of administration varied greatly, with a single dose being the most commonly used (39.53%. The time elapsed from trauma to treatment was 0-15 minutes (41.8%, 15-60 minutes (30% and over 60 minutes (10.6%. Histological analysis was performed in 32 studies (74.41%. The BBB scale was the main functional measure applied (55.8%, followed by the inclined plane test (16.2% and the Tarlov scale (13.9%. Positive outcomes were observed in 37 studies (86.04%. The heterogeneity of antioxidant therapy, with different types, doses, and measurements observed, limits the comparison of efficacy. Standardized protocols are required to make clinical translation possible.

  17. Relaxation Training and Postoperative Music Therapy for Adolescents Undergoing Spinal Fusion Surgery.

    Science.gov (United States)

    Nelson, Kirsten; Adamek, Mary; Kleiber, Charmaine

    2017-02-01

    Spinal fusion for idiopathic scoliosis is one of the most painful surgeries experienced by adolescents. Music therapy, utilizing music-assisted relaxation with controlled breathing and imagery, is a promising intervention for reducing pain and anxiety for these patients. It can be challenging to teach new coping strategies to post-operative patients who are already in pain. This study evaluated the effects of introducing music-assisted relaxation training to adolescents before surgery. Outcome measures were self-reported pain and anxiety, recorded on 0-10 numeric rating scale, and observed behavioral indicators of pain and relaxation. The training intervention was a 12-minute video about music-assisted relaxation with opportunities to practice before surgery. Forty-four participants between the ages of 10 and 19 were enrolled. Participants were randomly assigned to the experimental group that watched the video at the preoperative visit or to the control group that did not watch the video. All subjects received a music therapy session with a board certified music therapist on post-operative day 2 while out of bed for the first time. Pain and anxiety were significantly reduced from immediately pre-therapy to post-therapy (paired t-test; p). Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  18. EFFICACY OF SPINAL-CORD STIMULATION AS ADJUVANT THERAPY FOR INTRACTABLE ANGINA-PECTORIS - A PROSPECTIVE, RANDOMIZED CLINICAL-STUDY

    NARCIS (Netherlands)

    DEJONGSTE, MJL; HAUTVAST, RWM; HILLEGE, HL; LIE, KI

    Objectives. In a prospective, randomized study with an 8-week follow-up period, we evaluated the efficacy of spinal cord stimulation an exercise capacity and quality of life in patients with intractable angina. Background. Despite important achievements in therapy for ischemic heart disease, there

  19. Manual Therapy

    OpenAIRE

    Hakgüder, Aral; Kokino, Siranuş

    2002-01-01

    Manual therapy has been used in the treatment of pain and dysfunction of spinal and peripheral joints for more than a hundred years. Manual medicine includes manipulation, mobilization, and postisometric relaxation techniques. The aim of manual therapy is to enhance restricted movement caused by blockage of joints keeping postural balance, restore function and maintain optimal body mechanics. Anatomic, biomechanical, and neurophysiological evaluations of the leucomotor system is essential for...

  20. Feasibility of combination allogeneic stem cell therapy for spinal cord injury: a case report

    Directory of Open Access Journals (Sweden)

    Ichim Thomas E

    2010-11-01

    Full Text Available Abstract Cellular therapy for spinal cord injury (SCI is overviewed focusing on bone marrow mononuclear cells, olfactory ensheathing cells, and mesenchymal stem cells. A case is made for the possibility of combining cell types, as well as for allogeneic use. We report the case of 29 year old male who suffered a crush fracture of the L1 vertebral body, lacking lower sensorimotor function, being a score A on the ASIA scale. Stem cell therapy comprised of intrathecal administration of allogeneic umbilical cord blood ex-vivo expanded CD34 and umbilical cord matrix MSC was performed 5 months, 8 months, and 14 months after injury. Cell administration was well tolerated with no adverse effects observed. Neuropathic pain subsided from intermittent 10/10 to once a week 3/10 VAS. Recovery of muscle, bowel and sexual function was noted, along with a decrease in ASIA score to "D". This case supports further investigation into allogeneic-based stem cell therapies for SCI.

  1. Dose perturbation effect of metallic spinal implants in proton beam therapy.

    Science.gov (United States)

    Jia, Yingcui; Zhao, Li; Cheng, Chee-Wai; McDonald, Mark W; Das, Indra J

    2015-09-08

    The purpose of this study was to investigate the effect of dose perturbations for two metallic spinal screw implants in proton beam therapy in the perpendicular and parallel beam geometry. A 5.5 mm (diameter) by 45 mm (length) stainless steel (SS) screw and a 5.5 mm by 35 mm titanium (Ti) screw commonly used for spinal fixation were CT-scanned in a hybrid phantom of water and solid water. The CT data were processed with an orthopedic metal artifact reduction (O-MAR) algorithm. Treatment plans were generated for each metal screw with a proton beam oriented, first parallel and then perpendicular, to the longitudinal axis of the screw. The calculated dose profiles were compared with measured results from a plane-parallel ion chamber and Gafchromic EBT2 films. For the perpendicular setup, the measured dose immediately downstream from the screw exhibited dose enhancement up to 12% for SS and 8% for Ti, respectively, but such dose perturbation was not observed outside the lateral edges of the screws. The TPS showed 5% and 2% dose reductions immediately at the interface for the SS nd Ti screws, respectively, and up to 9% dose enhancements within 1 cm outside of the lateral edges of the screws. The measured dose enhancement was only observed within 5 mm from the interface along the beam path. At deeper depths, the lateral dose profiles appeared to be similar between the measurement and TPS, with dose reduction in the screw shadow region and dose enhancement within 1-2 cm outside of the lateral edges of the metals. For the parallel setup, no significant dose perturbation was detected at lateral distance beyond 3 mm away from both screws. Significant dose discrepancies exist between TPS calculations and ion chamber and film measurements in close proximity of high-Z inhomogeneities. The observed dose enhancement effect with proton therapy is not correctly modeled by TPS. An extra measure of caution should be taken when evaluating dosimetry with spinal metallic implants.

  2. The Associations Between Physical Therapy and Long-Term Outcomes for Individuals with Lumbar Spinal Stenosis in the SPORT study

    Science.gov (United States)

    Fritz, Julie M.; Lurie, Jon D.; Zhao, Wenyan; Whitman, Julie M.; Delitto, Anthony; Brennan, Gerard P.; Weinstein, James N.

    2013-01-01

    Background/Context A period of non-surgical management is advocated prior to surgical treatment for most patients with lumbar spinal stenosis. Currently, little evidence is available to define optimal non-surgical management. Physical therapy is often used, however its use and effectiveness relative to other non-surgical strategies has not been adequately explored. Purpose Describe the utilization of physical therapy and other non-surgical interventions by patients with lumbar spinal stenosis and examine the relationship between physical therapy and long-term prognosis. Study Design Secondary analysis of the Spine Patient Outcomes Research Trial (SPORT) combining data from randomized and observational studies. Setting 13 spine clinics in 11 states in the United States. Patient Sample Patients with lumbar spinal stenosis receiving non-surgical management including those who did or did not receive physical therapy within 6 weeks of enrollment. Outcome Measures Primary outcome measures included cross-over to surgery, the bodily pain and physical function scales changes from the Survey Short Form 36 (SF-36), and the modified Oswestry Disability Index. Secondary outcome measures were patient satisfaction and the Sciatica Bothersomeness Index. Methods Baseline characteristics and rates of cross-over to surgery were compared between patients who did or did not receive physical therapy. Baseline factors predictive of receiving physical therapy were examined with logistic regression. Mixed effects models were used to compare outcomes between groups at 3 and 6 months, and 1 year after enrollment adjusted for baseline severity and patient characteristics. Results Physical therapy was used in the first 6 weeks by 90 of 244 patients (37%) and was predicted by the absence of radiating pain and being single instead of married. Physical therapy was associated with a reduced likelihood of cross-over to surgery after 1 year (21% vs 33%, p=0.045), and greater reductions on the SF-36

  3. Effects of coordination and manipulation therapy for patients with Parkinson disease.

    Science.gov (United States)

    Zhao, Mingming; Hu, Caiyou; Wu, Zhixin; Chen, Yu; Li, Zhengming; Zhang, Mingsheng

    2017-09-01

    To determine the effects of a new exercise training regimen, i.e. coordination and manipulation therapy (CMT), on motor, balance, and cardiac functions in patients with Parkinson disease (PD). We divided 36 PD patients into the CMT (n = 22) and control (n = 14) groups. The patients in the CMT group performed dry-land swimming (imitation of the breaststroke) and paraspinal muscle stretching for 30 min/workday for 1 year. The control subjects did not exercise regularly. The same medication regimen was maintained in both groups during the study. Clinical characteristics, Unified Parkinson's Disease Rating Scale (UPDRS) scores, Berg balance scale (BBS) scores, mechanical balance measurements, timed up and go (TUG) test, and left ventricular ejection fraction (LVEF) were compared at 0 (baseline), 6, and 12 months. Biochemical test results were compared at 0 and 12 months. The primary outcome was motor ability. The secondary outcome was cardiac function. In the CMT group, UPDRS scores significantly improved, TUG test time and step number significantly decreased, BBS scores significantly increased, and most mechanical balance measurements significantly improved after 1 year of regular exercise therapy (all p < 0.05). In the control group, UPDRS scores significantly deteriorated, TUG test time and step number significantly increased, BBS scores significantly decreased, and most mechanical balance measurements significantly worsened after 1 year (all P < 0.05). LVEF improved in the CMT group only (P = 0.01). This preliminary study suggests that CMT effectively improved mobility disorder, balance, and cardiac function in PD patients over a 1-year period.

  4. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... of Spinal Cord Injury Rehabilitation Kristine Cichowski, MS Occupational Therapy after Spinal Cord Injury Katie Powell, OT ... does not provide medical advice, recommend or endorse health care products or services, or control the information ...

  5. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... RN Pediatric Injuries Pediatric Spinal Cord Injury 101 Lawrence Vogel, MD The Basics of Pediatric SCI Rehabilitation ... Rogers, PT Recreational Therapy after Spinal Cord Injury Jennifer Piatt, PhD David Chen, MD Read Bio Medical ...

  6. Long-term safety and efficacy of fractionated stereotactic body radiation therapy for spinal metastases

    Energy Technology Data Exchange (ETDEWEB)

    Mantel, Frederick; Glatz, Stefan; Toussaint, Andre; Flentje, Michael; Guckenberger, Matthias [University Hospital Wuerzburg, Department of Radiation Oncology, Wuerzburg (Germany)

    2014-12-15

    Patients with long life expectancy despite metastatic status might benefit from long-term local control of spinal metastases. Dose-intensified radiotherapy (RT) is believed to control tumor growth better and thus offers longer pain relief. This single-institution study reports on fractionated stereotactic body radiation therapy (SBRT) for spinal metastases in patients with good life expectancy based on performance status, extent of metastases, histology, and time to metastasis. Between 2004 and 2010, 36 treatment sites in 32 patients (median age 55 years; male 61 %; median Karnofsky performance score 85) were treated with fractionated SBRT. The median treatment dose was 60 Gy (range, 48.5-65 Gy) given in a median of 20 fractions (range, 17-33); the median maximum dose to the planning risk volume for the spinal cord (PRV-SC) was 46.6 Gy. All patients suffering from pain prior to RT reported pain relief after treatment; after a median follow-up of 20.3 months, 61 % of treatment sites were pain-free, another 25 % associated with mild pain. In 86 % of treatments, patients were free from neurological symptoms at the time of the last clinical follow-up. Acute grade 1 toxicities (CTCAE 3.0) were observed in 11 patients. Myelopathy did not occur in any patient. Radiologically controlled freedom from local progression was 92 and 84 % after 12 and 24 months, respectively. Median overall survival (OS) was 19.6 months. Patient selection resulted in long OS despite metastatic disease, and dose-intensified fractionated SBRT for spinal metastases was safe and achieved long-term local tumor control and palliation of pain. (orig.) [German] Patienten mit guter Lebenserwartung trotz metastasierter Erkrankung koennten von einer lang andauernden lokalen Kontrolle von Wirbelsaeulenmetastasen profitieren. Eine dosisintensivierte Radiotherapie (RT) kann vermutlich eine bessere Tumorkontrolle und daher eine laengere Schmerzpalliation erreichen. Ausgewertet wurden die monozentrischen

  7. Predicting Neuroinflammation in Morphine Tolerance for Tolerance Therapy from Immunostaining Images of Rat Spinal Cord.

    Directory of Open Access Journals (Sweden)

    Shinn-Long Lin

    Full Text Available Long-term morphine treatment leads to tolerance which attenuates analgesic effect and hampers clinical utilization. Recent studies have sought to reveal the mechanism of opioid receptors and neuroinflammation by observing morphological changes of cells in the rat spinal cord. This work proposes a high-content screening (HCS based computational method, HCS-Morph, for predicting neuroinflammation in morphine tolerance to facilitate the development of tolerance therapy using immunostaining images for astrocytes, microglia, and neurons in the spinal cord. HCS-Morph first extracts numerous HCS-based features of cellular phenotypes. Next, an inheritable bi-objective genetic algorithm is used to identify a minimal set of features by maximizing the prediction accuracy of neuroinflammation. Finally, a mathematic model using a support vector machine with the identified features is established to predict drug-treated images to assess the effects of tolerance therapy. The dataset consists of 15 saline controls (1 μl/h, 15 morphine-tolerant rats (15 μg/h, and 10 rats receiving a co-infusion of morphine (15 μg/h and gabapentin (15 μg/h, Sigma. The three individual models of astrocytes, microglia, and neurons for predicting neuroinflammation yielded respective Jackknife test accuracies of 96.67%, 90.00%, and 86.67% on the 30 rats, and respective independent test accuracies of 100%, 90%, and 60% on the 10 co-infused rats. The experimental results suggest that neuroinflammation activity expresses more predominantly in astrocytes and microglia than in neuron cells. The set of features for predicting neuroinflammation from images of astrocytes comprises mean cell intensity, total cell area, and second-order geometric moment (relating to cell distribution, relevant to cell communication, cell extension, and cell migration, respectively. The present investigation provides the first evidence for the role of gabapentin in the attenuation of morphine tolerance from

  8. Development of telmisartan in the therapy of spinal cord injury: pre-clinical study in rats

    Directory of Open Access Journals (Sweden)

    Lin CM

    2015-08-01

    Full Text Available Chien-Min Lin,1,* Jo-Ting Tsai,2,* Chen Kuei Chang,1 Juei-Tang Cheng,3 Jia-Wei Lin11Department of Neurosurgery, 2Department of Radiation Oncology, Shuang Ho Hospital-Taipei Medical University, 3Institute of Medical Science, College of Health Science, Chang Jung Christian University, Tainan City, Taiwan*These authors contributed equally to this workBackground: Decrease of peroxisome proliferator-activated receptors-δ (PPARδ expression has been observed after spinal cord injury (SCI. Increase of PPARδ may improve the damage in SCI. Telmisartan, the antihypertensive agent, has been mentioned to increase the expression of PPARδ. Thus, we are going to screen the effectiveness of telmisartan in SCI for the development of it in clinical application.Methods: In the present study, we used compressive SCI in rats. Telmisartan was then used to evaluate the influence in rats after SCI. Change in PPARδ expression was identified by Western blots. Also, behavioral tests were performed to check the recovery of damage.Results: Recovery of damage from SCI was observed in telmisartan-treated rats. Additionally, this action of telmisartan was inhibited by GSK0660 at the dose sufficient to block PPARδ. However, metformin at the dose enough to activate adenosine monophosphate-activated protein kinase failed to produce similar action as telmisartan. Thus, mediation of adenosine monophosphate-activated protein kinase in this action of telmisartan can be rule out. Moreover, telmisartan reversed the expressions of PPARδ in rats with SCI.Conclusion: The obtained data suggest that telmisartan can improve the damage of SCI in rats through an increase in PPARδ expression. Thus, telmisartan is useful to be developed as an agent in the therapy of SCI.Keywords: PPARδ, AMPK, spinal cord injury, angiotensin receptor blocker, metformin

  9. Magnetic Resonance Imaging Assessment of Spinal Cord and Cauda Equina Motion in Supine Patients With Spinal Metastases Planned for Spine Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Tseng, Chia-Lin [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Sussman, Marshall S. [Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario (Canada); Atenafu, Eshetu G. [Department of Biostatistics, University Health Network, University of Toronto, Toronto, Ontario (Canada); Letourneau, Daniel [Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Ma, Lijun [Department of Radiation Oncology, University of California San Francisco, San Francisco, California (United States); Soliman, Hany; Thibault, Isabelle [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Cho, B. C. John; Simeonov, Anna [Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Yu, Eugene [Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario (Canada); Fehlings, Michael G. [Department of Neurosurgery and Spine Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario (Canada); Sahgal, Arjun, E-mail: arjun.sahgal@sunnybrook.ca [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada)

    2015-04-01

    Purpose: To assess motion of the spinal cord and cauda equina, which are critical neural tissues (CNT), which is important when evaluating the planning organ-at-risk margin required for stereotactic body radiation therapy. Methods and Materials: We analyzed CNT motion in 65 patients with spinal metastases (11 cervical, 39 thoracic, and 24 lumbar spinal segments) in the supine position using dynamic axial and sagittal magnetic resonance imaging (dMRI, 3T Verio, Siemens) over a 137-second interval. Motion was segregated according to physiologic cardiorespiratory oscillatory motion (characterized by the average root mean square deviation) and random bulk shifts associated with gross patient motion (characterized by the range). Displacement was evaluated in the anteroposterior (AP), lateral (LR), and superior-inferior (SI) directions by use of a correlation coefficient template matching algorithm, with quantification of random motion measure error over 3 separate trials. Statistical significance was defined according to P<.05. Results: In the AP, LR, and SI directions, significant oscillatory motion was observed in 39.2%, 35.1%, and 10.8% of spinal segments, respectively, and significant bulk motions in all cases. The median oscillatory CNT motions in the AP, LR, and SI directions were 0.16 mm, 0.17 mm, and 0.44 mm, respectively, and the maximal statistically significant oscillatory motions were 0.39 mm, 0.41 mm, and 0.77 mm, respectively. The median bulk displacements in the AP, LR, and SI directions were 0.51 mm, 0.59 mm, and 0.66 mm, and the maximal statistically significant displacements were 2.21 mm, 2.87 mm, and 3.90 mm, respectively. In the AP, LR, and SI directions, bulk displacements were greater than 1.5 mm in 5.4%, 9.0%, and 14.9% of spinal segments, respectively. No significant differences in axial motion were observed according to cord level or cauda equina. Conclusions: Oscillatory CNT motion was observed to be relatively minor. Our results

  10. The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial.

    Science.gov (United States)

    Moustafa, Ibrahim M; Diab, Aliaa A

    2015-07-01

    The aim of this study was to investigate the immediate and long-term effects of a one-year multimodal program, with the addition of upper cervical manipulative therapy, on fibromyalgia management outcomes in addition to three-dimensional (3D) postural measures. This randomized clinical trial with one-year follow-up was completed at the research laboratory of our university. A total of 120 (52 female) patients with fibromyalgia syndrome (FMS) and definite C1-2 joint dysfunction were randomly assigned to the control or an experimental group. Both groups received a multimodal program; additionally, the experimental group received upper cervical manipulative therapy. Primary outcomes were the Fibromyalgia Impact Questionnaire (FIQ), whereas secondary outcomes included Pain Catastrophizing Scale (PCS), algometric score, Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and 3D postural measures. Measures were assessed at three time intervals: baseline, 12 weeks, and 1 year after the 12-week follow-up. The general linear model with repeated measures indicated a significant group × time effect in favor of the experimental group on the measures of 3D postural parameters (P < .0005), FIQ (P < .0005), PCS (P < .0005), algometric score (F = P < .0005), PSQI (P < .0005), BAI (P < .0005), and BDI (P < .0005). The addition of the upper cervical manipulative therapy to a multimodal program is beneficial in treating patients with FMS.

  11. Symptomatic, MRI Confirmed, Lumbar Disc Herniations: A Comparison of Outcomes Depending on the Type and Anatomical Axial Location of the Hernia in Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulation.

    Science.gov (United States)

    Ehrler, Marco; Peterson, Cynthia; Leemann, Serafin; Schmid, Christof; Anklin, Bernard; Humphreys, B Kim

    2016-01-01

    The purpose of this study was to evaluate whether specific MRI features, such as axial location and type of herniation, are associated with outcomes of symptomatic lumbar disc herniation patients treated with spinal manipulation therapy (SMT). MRI and treatment outcome data from 68 patients were included in this prospective outcomes study. Pain numerical rating scale (NRS) and Oswestry physical disability questionnaire (OPDQ) levels were measured at baseline. The Patients Global Impression of Change scale, the NRS and the OPDQ were collected at 2 weeks, 1, 3, 6 months and 1 year. One radiologist and 2 chiropractic medicine master's degree students analyzed the MRI scans blinded to treatment outcomes. κ statistics assessed inter-rater reliability of MRI diagnosis. The proportion of patients reporting relevant improvement at each time point was compared based on MRI findings using the chi-square test. The t test and ANOVA compared the NRS and OPDQ change scores between patients with various MRI abnormalities. A higher proportion of patients with disc sequestration reported relevant improvement at each time point but this did not quite reach statistical significance. Patients with disc sequestration had significantly higher reduction in leg pain at 1 month compared to those with extrusion (P = .02). Reliability of MRI diagnosis ranged from substantial to perfect (K = .733-1.0). Patients with sequestered herniations treated with SMT to the level of herniation reported significantly higher levels of leg pain reduction at 1 month and a higher proportion reported improvement at all data collection time points but this did not reach statistical significance. Copyright © 2016 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  12. Comparative short-term effects of two thoracic spinal manipulation techniques in subjects with chronic mechanical neck pain: a randomized controlled trial.

    Science.gov (United States)

    Casanova-Méndez, Amaloha; Oliva-Pascual-Vaca, Angel; Rodriguez-Blanco, Cleofás; Heredia-Rizo, Alberto Marcos; Gogorza-Arroitaonandia, Kristobal; Almazán-Campos, Ginés

    2014-08-01

    Spinal Manipulation (SM) has been purported to decrease pain and improve function in subjects with non-specific neck pain. Previous research has investigated which individuals with non-specific neck pain will be more likely to benefit from SM. It has not yet been proven whether or not the effectiveness of thoracic SM depends on the specific technique being used. This double-blind randomized trial has compared the short-term effects of two thoracic SM maneuvers in subjects with chronic non-specific neck pain. Sixty participants were distributed randomly into two groups. One group received the Dog technique (n = 30), with the subject in supine position, and the other group underwent the Toggle-Recoil technique (n = 30), with the participant lying prone, T4 being the targeted area in both cases. Evaluations were made of self-reported neck pain (Visual Analogue Scale); neck mobility (Cervical Range of Motion); and pressure pain threshold at the cervical and thoracic levels (C4 and T4 spinous process) and over the site described for location of tense bands of the upper trapezius muscle. Measurements were taken before intervention, immediately afterward, and 20 min later. Both maneuvers improved neck mobility and mechanosensitivity and reduced pain in the short term. No major or clinical differences were found between the groups. In the between-groups comparison slightly better results were observed in the Toggle-Recoil group only for cervical extension (p = 0.009), right lateral flexion (p = 0.004) and left rotation (p < 0.05). Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. An effective strategy of magnetic stem cell delivery for spinal cord injury therapy

    Science.gov (United States)

    Tukmachev, Dmitry; Lunov, Oleg; Zablotskii, Vitalii; Dejneka, Alexandr; Babic, Michal; Syková, Eva; Kubinová, Šárka

    2015-02-01

    Spinal cord injury (SCI) is a condition that results in significant mortality and morbidity. Treatment of SCI utilizing stem cell transplantation represents a promising therapy. However, current conventional treatments are limited by inefficient delivery strategies of cells into the injured tissue. In this study, we designed a magnetic system and used it to accumulate stem cells labelled with superparamagnetic iron oxide nanoparticles (SPION) at a specific site of a SCI lesion. The loading of stem cells with engineered SPIONs that guarantees sufficient attractive magnetic forces was achieved. Further, the magnetic system allowed rapid guidance of the SPION-labelled cells precisely to the lesion location. Histological analysis of cell distribution throughout the cerebrospinal channel showed a good correlation with the calculated distribution of magnetic forces exerted onto the transplanted cells. The results suggest that focused targeting and fast delivery of stem cells can be achieved using the proposed non-invasive magnetic system. With future implementation the proposed targeting and delivery strategy bears advantages for the treatment of disease requiring fast stem cell transplantation.Spinal cord injury (SCI) is a condition that results in significant mortality and morbidity. Treatment of SCI utilizing stem cell transplantation represents a promising therapy. However, current conventional treatments are limited by inefficient delivery strategies of cells into the injured tissue. In this study, we designed a magnetic system and used it to accumulate stem cells labelled with superparamagnetic iron oxide nanoparticles (SPION) at a specific site of a SCI lesion. The loading of stem cells with engineered SPIONs that guarantees sufficient attractive magnetic forces was achieved. Further, the magnetic system allowed rapid guidance of the SPION-labelled cells precisely to the lesion location. Histological analysis of cell distribution throughout the cerebrospinal

  14. Systematic review and comparison of pharmacologic therapies for neuropathic pain associated with spinal cord injury

    Directory of Open Access Journals (Sweden)

    Snedecor SJ

    2013-07-01

    Full Text Available Sonya J Snedecor,1 Lavanya Sudharshan,1 Joseph C Cappelleri,2 Alesia Sadosky,3 Pooja Desai,4 Yash J Jalundhwala,5 Marc Botteman1 1Pharmerit International, Bethesda, MD, USA; 2Global Research and Development, Pfizer, Groton, CT, USA; 3Biostatistics, Pfizer, New York, NY, USA; 4College of Pharmacy, University of Texas at Austin, Austin, TX, USA; 5Pharmacy Administration, University of Illinois at Chicago, Chicago, IL, USA Background: Management of neuropathic pain (NeP associated with spinal cord injury (SCI is difficult. This report presents a systematic literature review and comparison of the efficacy and safety of pharmacologic therapies for treating SCI-associated NeP. Methods: Medline, Embase, Cochrane, and Database of Abstracts of Reviews of Effects were searched through December 2011 for randomized, blinded, and controlled clinical trials of SCI-associated NeP meeting predefined inclusion criteria. Efficacy outcomes of interest were pain reduction on the 11-point numeric rating scale (NRS or 100 mm visual analog scale and proportion of patients achieving ≥30% or ≥50% pain reduction. Discontinuations and adverse events (AEs were also assessed, for which Bayesian meta-analytic indirect comparisons were performed. Results: Of the nine studies included in the analysis, samples were <100 patients, except for one pregabalin study (n = 136. Standard errors for the NRS outcome were often not reported, precluding quantitative comparisons across treatments. Estimated 11-point NRS pain reduction relative to placebo was –1.72 for pregabalin, –1.65 for amitriptyline, –1.0 for duloxetine, –1 (median for levetiracetam, –0.27 for gabapentin, 1 (median for lamotrigine, and 2 for dronabinol. Risk ratios relative to placebo for 30% improvement were 0.71 for levetiracetam and 2.56 for pregabalin, and 0.94 and 2.91, respectively, for 50% improvement. Meta-analytic comparisons showed significantly more AEs with pregabalin and tramadol compared with

  15. The MR imaging and DSA features and embolization therapy of spinal dural arteriovenous fistulae

    International Nuclear Information System (INIS)

    Zhang Hua; Hu Jinqing; Lin Dong; Wu Daming; Wang Dengbin; Yang Yanmin; Cheng Kemin

    2005-01-01

    Objective: To investigate the MR imaging and DSA features together with endovascular embolization of spinal dural arteriovenous fistulae (SDAVF). Methods: Twelve patients with SDAVF underwent both MR imaging and angiography of spinal cord, 4 of them received endovascular embolization. The imaging findings of MRI and angiography in all patients were analyzed. Results: Among 12 cases with SDAVF, 11 cases showed diffuse long T 2 signal, 2 cases demonstrated inhomogeneous maculate enhancement in the spinal cord and 6 cases revealed abnormal vessels in the dorsal spaces of spinal cord on MRI. Angiography of spinal cord showed orifices of all fistulae, draining veins, the extent of lesions, amount of feeding vessels and the angiographic features in all the 12 cases. 4 cases with embolization treatment showed improvement clinically. Conclusions: Angiography of spinal cord is the main method and MRI provides important assistance for diagnosing SDAVF while endovascular embolization is an effective method for the treatment. (authors)

  16. An evaluation of virtual reality technology as an occupational therapy treatment tool in spinal cord injury rehabilitation

    LENUS (Irish Health Repository)

    McNamara, Angela Dr.

    2006-01-01

    The introduction of virtual reality (VR) games as an occupational therapy (OT) treatment tool is an attempt to use technology as purposeful activity that is more relevant to a modern patient population than traditional art and craft based activities. It is unclear however if VR games are suitable for clinical applications and the current project examines the usability of video-capture VR games in spinal cord injury (SCI) rehabilitation.\\r\

  17. Workshop to address gaps in regulation of minimally manipulated autologous cell therapies for homologous use in Canada.

    Science.gov (United States)

    Chisholm, Jolene; von Tigerstrom, Barbara; Bedford, Patrick; Fradette, Julie; Viswanathan, Sowmya

    2017-12-01

    In Canada, minimally manipulated autologous cell therapies for homologous use (MMAC-H) are either regulated under the practice of medicine, or as drugs or devices under the Food and Drugs Act, Food and Drug Regulations (F&DR) or Medical Device Regulations (MDR). Cells, Tissues and Organs (CTO) Regulations in Canada are restricted to minimally manipulated allogeneic products for homologous use. This leaves an important gap in the interpretation of existing regulations. The purposes of this workshop co-organized by the Stem Cell Network and the Centre for Commercialization of Regenerative Medicine (CCRM) were to discuss the current state of regulation of MMAC-H therapies in Canada and compare it with other regulatory jurisdictions, with the intent of providing specific policy recommendations to Health Canada. Participants came to a consensus on the need for well-defined common terminology between regulators and stakeholders, a common source of confusion and misinformation. A need for a harmonized national approach to oversight of facilities providing MMAC-H therapies based on existing standards, such as Canadian Standards Association (CSA), was also voiced. Facilities providing MMAC-H therapies should also participate in collection of long-term data to ensure patient safety and efficacy of therapies. Harmonization across provinces of the procedures and practices involving administration of MMAC-H would be preferred. Participants felt that devices used to process MMAC-H are adequately regulated under existing MDR. Overly prescriptive regulation will stifle innovation, whereas insufficient regulation might allow unsafe or ineffective therapies to be offered. Until a clear, balanced and explicit approach is articulated, regulatory uncertainty remains a barrier. Copyright © 2017 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

  18. The impact of chiropractic manipulative therapy on chronic recurrent lateral ankle sprain syndrome in two young athletes.

    Science.gov (United States)

    Gillman, Scott F

    2004-01-01

    To describe two cases of abrupt resolution of chronic, recurrent, inversion sprain to ankles in young recreational athletes. A 13-year-old, female, avid recreational soccer player with ankles that would spontaneously invert during various inconsistent points in the weight bearing gait cycle, sometimes with acute pain or sprain to the ankle. No intervention was attempted prior to her entry to the chiropractic office. A 17-year-old male avid skate- boarder and snowboarder whose left ankle routinely "gave out" into inversion upon mundane weight bearing activity, usually with pain and with dependence on wearing an ankle support when skateboarding to lessen ankle pain. The patient had used an ankle support prior to seeking chiropractic care. High velocity, low amplitude chiropractic manipulative therapy applied to the spine, pelvis and extremity joints was the primary intervention in both cases, with particular focus on the ankle. Other procedures used included taping and orthotics, but not before the manipulation effect was noted. High velocity, low amplitude chiropractic manipulative therapy to the spine, pelvis, and extremities, particularly at the ankle, should be considered when managing young recreational athletes with functional chronic, recurrent, ankle inversion sprains.

  19. Efficacy of manual and manipulative therapy in the perception of pain and cervical motion in patients with tension-type headache: a randomized, controlled clinical trial.

    Science.gov (United States)

    Espí-López, Gemma V; Gómez-Conesa, Antonia

    2014-03-01

    The purpose of this study was to evaluate the efficacy of manipulative and manual therapy treatments with regard to pain perception and neck mobility in patients with tension-type headache. A randomized clinical trial was conducted on 84 adults diagnosed with tension-type headache. Eighty-four subjects were enrolled in this study: 68 women and 16 men. Mean age was 39.76 years, ranging from 18 to 65 years. A total of 57.1% were diagnosed with chronic tension-type headache and 42.9% with tension-type headache. Participants were divided into 3 treatment groups (manual therapy, manipulative therapy, a combination of manual and manipulative therapy) and a control group. Four treatment sessions were administered during 4 weeks, with posttreatment assessment and follow-up at 1 month. Cervical ranges of motion pain perception, and frequency and intensity of headaches were assessed. All 3 treatment groups showed significant improvements in the different dimensions of pain perception. Manual therapy and manipulative treatment improved some cervical ranges of motion. Headache frequency was reduced with manipulative treatment (P treatment reported improvement after the treatment (P treatment and at follow-up with manipulative therapy (P treatment (P treatments, administered both separately and combined together, showed efficacy for patients with tension-type headache with regard to pain perception. As for cervical ranges of motion, treatments produced greater effect when separately administered.

  20. Reduction in high blood tumor necrosis factor-alpha levels after manipulative therapy in 2 cervicogenic headache patients.

    Science.gov (United States)

    Ormos, Gábor; Mehrishi, J N; Bakács, Tibor

    2009-09-01

    This case report discusses the treatment of 2 patients with cervicogenic headache (CHA) attending the Outpatient Clinic of the Hungarian National Institute for Rheumatology and Physiotherapy (Budapest, Hungary) and reviews the pathophysiology, therapeutic strategy, and problems associated with the treatment of CHA. Patient 1 was a 27-year-old female who sustained a whiplash injury. A sharp, shooting headache developed, readily induced, and aggravated by just bending the neck backward or by turning her head. Magnetic resonance imaging revealed a disk protrusion at C4-C5 pressing the anterior cerebrospinal space. Patient 2 was a 62-year-old female who sustained a whiplash injury; her cervical movements became restricted, which precipitated headaches. Magnetic resonance imaging revealed a paramedian disk hernia between the C4 and C5 vertebrae that intruded into the right ventral cerebrospinal space. After 4 weeks of manipulative therapy for patient 1, both active and passive range of motion returned to normal, and the high tumor necrosis factor-alpha (TNF-alpha) level (63 pg/mL) was substantially reduced (28 pg/mL). Patient 2 was started on manipulative therapy twice a week for 4 weeks; after 2 months, the patient became symptom-free, and high TNF-alpha level (72 pg/mL) was reduced greatly (35 pg/mL). Two patients with whiplash injury and disk herniation developed CHA associated with very high TNF-alpha levels. After manipulative therapy, these patients became symptom-free, and their TNF-alpha levels decreased substantially.

  1. Isometric muscle training of the spine musculature in patients with spinal bony metastases under radiation therapy

    International Nuclear Information System (INIS)

    Rief, Harald; Jensen, Alexandra D; Bruckner, Thomas; Herfarth, Klaus; Debus, Jürgen

    2011-01-01

    Osseous metastatic involvement of the spinal column affects many patients with a primary tumour disease of all entities. The consequences are pain both at rest and under exertion, impairments in going about day-to-day activities, diminished performance, the risk of pathological fractures, and neurological deficits. Palliative percutaneous radiotherapy is one of the therapeutical options available in this connection. The aim of this explorative study is to investigate the feasibility of muscle-training exercises and to evaluate the progression- and fracture-free survival time and the improvement of bone density, as well as to assess other clinical parameters such as pain, quality of life, and fatigue as secondary endpoints. This study is a prospective, randomized, monocentre, controlled explorative intervention study in the parallel-group design to determine the multidimensional effects of a course of exercises at first under physiotherapeutic instruction and subsequently performed by the patients independently for strengthening the paravertebral muscles of patients with metastases of the vertebral column parallel to their percutaneous radiotherapy. On the days of radiation treatment the patients in the control group shall be given physical treatment in the form of respiratory therapy and the so-called 'hot roll'. The patients will be randomized into one of the two groups: differentiated muscle training or physiotherapy with thirty patients in each group. The aim of the study is to evaluate the feasibility of the training programme described here. Progression-free and fracture-free survival, improved response to radiotherapy by means of bone density, and clinical parameters such as pain, quality of life, and fatigue constitute secondary study objectives. ClinicalTrials.gov: http://www.clinicaltrials.gov/ct2/show/NCT01409720

  2. A Systematic Review of Cellular Transplantation Therapies for Spinal Cord Injury

    Science.gov (United States)

    Okon, Elena B.; Karimi-Abdolrezaee, Soheila; Hill, Caitlin E.; Sparling, Joseph S.; Plemel, Jason R.; Plunet, Ward T.; Tsai, Eve C.; Baptiste, Darryl; Smithson, Laura J.; Kawaja, Michael D.; Fehlings, Michael G.; Kwon, Brian K.

    2011-01-01

    Abstract Cell transplantation therapies have become a major focus in pre-clinical research as a promising strategy for the treatment of spinal cord injury (SCI). In this article, we systematically review the available pre-clinical literature on the most commonly used cell types in order to assess the body of evidence that may support their translation to human SCI patients. These cell types include Schwann cells, olfactory ensheathing glial cells, embryonic and adult neural stem/progenitor cells, fate-restricted neural/glial precursor cells, and bone-marrow stromal cells. Studies were included for review only if they described the transplantation of the cell substrate into an in-vivo model of traumatic SCI, induced either bluntly or sharply. Using these inclusion criteria, 162 studies were identified and reviewed in detail, emphasizing their behavioral effects (although not limiting the scope of the discussion to behavioral effects alone). Significant differences between cells of the same “type” exist based on the species and age of donor, as well as culture conditions and mode of delivery. Many of these studies used cell transplantations in combination with other strategies. The systematic review makes it very apparent that cells derived from rodent sources have been the most extensively studied, while only 19 studies reported the transplantation of human cells, nine of which utilized bone-marrow stromal cells. Similarly, the vast majority of studies have been conducted in rodent models of injury, and few studies have investigated cell transplantation in larger mammals or primates. With respect to the timing of intervention, nearly all of the studies reviewed were conducted with transplantations occurring subacutely and acutely, while chronic treatments were rare and often failed to yield functional benefits. PMID:20146557

  3. Low-Grade Inflammation and Spinal Cord Injury: Exercise as Therapy?

    Directory of Open Access Journals (Sweden)

    Eduardo da Silva Alves

    2013-01-01

    Full Text Available An increase in the prevalence of obesity in people with spinal cord injury can contribute to low-grade chronic inflammation and increase the risk of infection in this population. A decrease in sympathetic activity contributes to immunosuppression due to the lower activation of immune cells in the blood. The effects of physical exercise on inflammatory parameters in individuals with spinal cord injury have not been well described. We conducted a review of the literature published from 1974 to 2012. This review explored the relationships between low-grade inflammation, spinal cord injury, and exercise to discuss a novel mechanism that might explain the beneficial effects of exercise involving an increase in catecholamines and cytokines in people with spinal cord injury.

  4. Low-Grade Inflammation and Spinal Cord Injury: Exercise as Therapy?

    Science.gov (United States)

    da Silva Alves, Eduardo; de Aquino Lemos, Valdir; Ruiz da Silva, Francieli; Lira, Fabio Santos; dos Santos, Ronaldo Vagner Thomathieli; Rosa, João Paulo Pereira; Caperuto, Erico; Tufik, Sergio; de Mello, Marco Tulio

    2013-01-01

    An increase in the prevalence of obesity in people with spinal cord injury can contribute to low-grade chronic inflammation and increase the risk of infection in this population. A decrease in sympathetic activity contributes to immunosuppression due to the lower activation of immune cells in the blood. The effects of physical exercise on inflammatory parameters in individuals with spinal cord injury have not been well described. We conducted a review of the literature published from 1974 to 2012. This review explored the relationships between low-grade inflammation, spinal cord injury, and exercise to discuss a novel mechanism that might explain the beneficial effects of exercise involving an increase in catecholamines and cytokines in people with spinal cord injury. PMID:23533315

  5. Low-Grade Inflammation and Spinal Cord Injury: Exercise as Therapy?

    OpenAIRE

    da Silva Alves, Eduardo; de Aquino Lemos, Valdir; Ruiz da Silva, Francieli; Lira, Fabio Santos; dos Santos, Ronaldo Vagner Thomathieli; Rosa, Jo?o Paulo Pereira; Caperuto, Erico; Tufik, Sergio; de Mello, Marco Tulio

    2013-01-01

    An increase in the prevalence of obesity in people with spinal cord injury can contribute to low-grade chronic inflammation and increase the risk of infection in this population. A decrease in sympathetic activity contributes to immunosuppression due to the lower activation of immune cells in the blood. The effects of physical exercise on inflammatory parameters in individuals with spinal cord injury have not been well described. We conducted a review of the literature published from 1974 to ...

  6. Manipulative therapy in addition to usual medical care accelerates recovery of shoulder complaints at higher costs: economic outcomes of a randomized trial

    Directory of Open Access Journals (Sweden)

    Bergman Gert JD

    2010-09-01

    Full Text Available Abstract Background Shoulder complaints are common in primary care and have unfavourable long term prognosis. Our objective was to evaluate the clinical effectiveness of manipulative therapy of the cervicothoracic spine and the adjacent ribs in addition to usual medical care (UMC by the general practitioner in the treatment of shoulder complaints. Methods This economic evaluation was conducted alongside a randomized trial in primary care. Included were 150 patients with shoulder complaints and a dysfunction of the cervicothoracic spine and adjacent ribs. Patients were treated with UMC (NSAID's, corticosteroid injection or referral to physical therapy and were allocated at random (yes/no to manipulative therapy (manipulation and mobilization. Patient perceived recovery, severity of main complaint, shoulder pain, disability and general health were outcome measures. Data about direct and indirect costs were collected by means of a cost diary. Results Manipulative therapy as add-on to UMC accelerated recovery on all outcome measures included. At 26 weeks after randomization, both groups reported similar recovery rates (41% vs. 38%, but the difference between groups in improvement of severity of the main complaint, shoulder pain and disability sustained. Compared to the UMC group the total costs were higher in the manipulative group (€1167 vs. €555. This is explained mainly by the costs of the manipulative therapy itself and the higher costs due sick leave from work. The cost effectiveness ratio showed that additional manipulative treatment is more costly but also more effective than UMC alone. The cost-effectiveness acceptability curve shows that a 50%-probability of recovery with AMT within 6 months after initiation of treatment is achieved at €2876. Conclusion Manipulative therapy in addition to UMC accelerates recovery and is more effective than UMC alone on the long term, but is associated with higher costs. International Standard

  7. Positional uncertainties on sterotactic radiosurgery for spinal metastases using volumetric modulated arc therapy

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Seung Hyuck; Park, So Yeon; Kim, Jin Ho; Kim, Jung In; Park, Jong Min [Dept. of Nuclear Engineering, Seoul National University Hospital, Seoul (Korea, Republic of)

    2016-04-15

    For spinal metastatic cancers, stereotactic radiosurgery (SRS) plays a key role in tumor control and pain relief by delivering high doses to the lesions. Dose limiting factor to this treatment is spinal cord tolerance. Radiation-induced spinal cord injury, although uncommon, can result in paralysis, sensory deficits, or Brown-Sequard syndrome. Hence, various efforts are necessary to eliminate the risk of radiation myelitis, while keeping adequate dose delivery to target volumes. The Body-FIX system is employed to immobilize the patients. Despite these efforts, residual setup errors and intrafraction motions can cause dosimetric uncertainties. In this context, this study aimed to investigate residual setup errors and intrafraction motions in SRS of spinal metastasis. With appropriate immobilization and 4 DoF corrections, an 1-mm PTV margin is adequate for CTV coverage, accounting for both residual errors. Even with an perfect 6 DoF correction, at least 1-mm PTV margin is still necessary to address intrafraction motions. Given the fixed relative position between the spinal cord and vertebrae, it is assumed that the spinal cord is subject to a same degree of positional uncertainty.

  8. Reducing the cesarean delivery rates for breech presentations: administration of spinal anesthesia facilitates manipulation to cephalic presentation, but is it cost saving?

    Science.gov (United States)

    2014-01-01

    Background External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Neuraxial analgesia can increase the success rate of ECV significantly, potentially reducing cesarean delivery rates for breech presentation. The current study aims to determine whether the additional cost to the hospital of spinal anesthesia for ECV is offset by cost savings generated by reduced cesarean delivery. Methods In our tertiary hospital, three variables manpower, disposables, and fixed costs were calculated for ECV, ECV plus anesthetic doses of spinal block, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Manpower data were obtained from management payroll, fixed costs by calculating cost/lifetime usage rate and disposables were micro-costed in 2008, expressed in 2013 NIS. Results Cesarean delivery is the most expensive option, 11670.54 NIS and vaginal delivery following successful ECV under spinal block costs 5497.2 NIS. ECV alone costs 960.21 NIS, ECV plus spinal anesthesia costs 1386.97 NIS. The highest individual cost items for vaginal, cesarean delivery and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). ECV with spinal block is cheaper due to lower expected cesarean delivery rate and its lower associated costs. Conclusions The additional cost of the spinal anesthesia is offset by increased success rates for the ECV procedure resulting in reduction in the cesarean delivery rate. PMID:24564984

  9. Adverse events following cervical manipulative therapy: consensus on classification among Dutch medical specialists, manual therapists, and patients.

    Science.gov (United States)

    Kranenburg, Hendrikus A; Lakke, Sandra E; Schmitt, Maarten A; Van der Schans, Cees P

    2017-12-01

    To obtain consensus-based agreement on a classification system of adverse events (AE) following cervical spinal manipulation. The classification system should be comprised of clear definitions, include patients' and clinicians' perspectives, and have an acceptable number of categories. Design : A three-round Delphi study. Participants : Thirty Dutch participants (medical specialists, manual therapists, and patients) participated in an online survey. Procedure : Participants inventoried AE and were asked about their preferences for either a three- or a four-category classification system. The identified AE were classified by two analysts following the International Classification of Functioning, Disability and Health (ICF), and the International Classification of Diseases and Related Health Problems (ICD-10). Participants were asked to classify the severity for all AE in relation to the time duration. Consensus occurred in a three-category classification system. There was strong consensus for 16 AE in all severities (no, minor, and major AE) and all three time durations [hours, days, weeks]. The 16 AE included anxiety, flushing, skin rash, fainting, dizziness, coma, altered sensation, muscle tenderness, pain, increased pain during movement, radiating pain, dislocation, fracture, transient ischemic attack, stroke, and death. Mild to strong consensus was reached for 13 AE. A consensus-based classification system of AE is established which includes patients' and clinicians' perspectives and has three categories. The classification comprises a precise description of potential AE in accordance with internationally accepted classifications. After international validation, clinicians and researchers may use this AE classification system to report AE in clinical practice and research.

  10. Manipulation of biliary lipids by gene therapy: potential consequences for patients with progressive familial intrahepatic cholestasis

    NARCIS (Netherlands)

    Oude Elferink, Ronald P. J.

    2005-01-01

    Gene therapy constitutes a great promise for the treatment of inherited diseases as well as cancer. Although the principle is extremely elegant, reality proves that several important problems remain to be solved before gene therapy becomes a standard application for these conditions. Meanwhile, and

  11. Does combined therapy of curcumin and epigallocatechin gallate have a synergistic neuroprotective effect against spinal cord injury?

    Directory of Open Access Journals (Sweden)

    Jiri Ruzicka

    2018-01-01

    Full Text Available Systematic inflammatory response after spinal cord injury (SCI is one of the factors leading to lesion development and a profound degree of functional loss. Anti-inflammatory compounds, such as curcumin and epigallocatechin gallate (EGCG are known for their neuroprotective effects. In this study, we investigated the effect of combined therapy of curcumin and EGCG in a rat model of acute SCI induced by balloon compression. Immediately after SCI, rats received curcumin, EGCG, curcumin + EGCG or saline [daily intraperitoneal doses (curcumin, 6 mg/kg; EGCG 17 mg/kg] and weekly intramuscular doses (curcumin, 60 mg/kg; EGCG 17 mg/kg] for 28 days. Rats were evaluated using behavioral tests (the Basso, Beattie, and Bresnahan (BBB open-field locomotor test, flat beam test. Spinal cord tissue was analyzed using histological methods (Luxol Blue-cresyl violet staining and immunohistochemistry (anti-glial fibrillary acidic protein, anti-growth associated protein 43. Cytokine levels (interleukin-1β, interleukin-4, interleukin-2, interleukin-6, macrophage inflammatory protein 1-alpha, and RANTES were measured using Luminex assay. Quantitative polymerase chain reaction was performed to determine the relative expression of genes (Sort1, Fgf2, Irf5, Mrc1, Olig2, Casp3, Gap43, Gfap, Vegf, NfκB, Cntf related to regenerative processes in injured spinal cord. We found that all treatments displayed significant behavioral recovery, with no obvious synergistic effect after combined therapy of curcumin and ECGC. Curcumin and EGCG alone or in combination increased axonal sprouting, decreased glial scar formation, and altered the levels of macrophage inflammatory protein 1-alpha, interleukin-1β, interleukin-4 and interleukin-6 cytokines. These results imply that although the expected synergistic response of this combined therapy was less obvious, aspects of tissue regeneration and immune responses in severe SCI were evident.

  12. Does combined therapy of curcumin and epigallocatechin gallate have a synergistic neuroprotective effect against spinal cord injury?

    Science.gov (United States)

    Ruzicka, Jiri; Urdzikova, Lucia Machova; Svobodova, Barbora; Amin, Anubhav G; Karova, Kristyna; Dubisova, Jana; Zaviskova, Kristyna; Kubinova, Sarka; Schmidt, Meic; Jhanwar-Uniyal, Meena; Jendelova, Pavla

    2018-01-01

    Systematic inflammatory response after spinal cord injury (SCI) is one of the factors leading to lesion development and a profound degree of functional loss. Anti-inflammatory compounds, such as curcumin and epigallocatechin gallate (EGCG) are known for their neuroprotective effects. In this study, we investigated the effect of combined therapy of curcumin and EGCG in a rat model of acute SCI induced by balloon compression. Immediately after SCI, rats received curcumin, EGCG, curcumin + EGCG or saline [daily intraperitoneal doses (curcumin, 6 mg/kg; EGCG 17 mg/kg)] and weekly intramuscular doses (curcumin, 60 mg/kg; EGCG 17 mg/kg)] for 28 days. Rats were evaluated using behavioral tests (the Basso, Beattie, and Bresnahan (BBB) open-field locomotor test, flat beam test). Spinal cord tissue was analyzed using histological methods (Luxol Blue-cresyl violet staining) and immunohistochemistry (anti-glial fibrillary acidic protein, anti-growth associated protein 43). Cytokine levels (interleukin-1β, interleukin-4, interleukin-2, interleukin-6, macrophage inflammatory protein 1-alpha, and RANTES) were measured using Luminex assay. Quantitative polymerase chain reaction was performed to determine the relative expression of genes (Sort1, Fgf2, Irf5, Mrc1, Olig2, Casp3, Gap43, Gfap, Vegf, NfκB, Cntf) related to regenerative processes in injured spinal cord. We found that all treatments displayed significant behavioral recovery, with no obvious synergistic effect after combined therapy of curcumin and ECGC. Curcumin and EGCG alone or in combination increased axonal sprouting, decreased glial scar formation, and altered the levels of macrophage inflammatory protein 1-alpha, interleukin-1β, interleukin-4 and interleukin-6 cytokines. These results imply that although the expected synergistic response of this combined therapy was less obvious, aspects of tissue regeneration and immune responses in severe SCI were evident.

  13. [Development of a Novel Liposomal DDS by Manipulating Pharmacokinetics and Intracellular Trafficking for Drug Therapy and Nucleic Acid Medicine].

    Science.gov (United States)

    Hatakeyama, Hiroto

    2018-01-01

     Nucleic acid therapy is expected to be a next generation medicine. We recently developed a multifunctional envelope-type nano device (MEND) for use as a novel delivery system. The modification of polyethylene glycol (PEG), i.e., PEGylation, is useful for achieving the delivery of MENDs to tumors via an enhanced permeability and retention (EPR) effect. However, PEGylation strongly inhibits the cellular uptake and endosomal escape of MEND, which results in significant loss of action, and therefore lost effectiveness, of the cargo therapeutic. For successful nucleic acid delivery in cancer treatment, the crucial problem associated with the use of PEG, known as the "PEG dilemma", must be solved. In this review, we describe the development and application of MEND in overcoming the PEG dilemma based on manipulating both the pharmacokinetics and intracellular trafficking of cellular uptake and endosomal release using a cleavable PEG lipid, a pH-sensitive fusogenic peptide, and a pH-sensitive cationic lipid. We also developed dual-ligand liposomes with a controlled diameter of around 300 nm, then modified these with a specific ligand and a cell penetrating peptide designed to target the neovasculature of tumors. Dual-ligand liposomes could induce an anti-tumor effect in drug resistant tumors by delivering drugs to tumor blood vessels, rather than to the cancer cells themselves. Here, we review our recent efforts to develop a novel liposomal drug delivery system (DDS) by manipulating pharmacokinetics and intracellular trafficking for drug therapy and nucleic acid medicine.

  14. Case report on the clinical results of a combined cellular therapy for chronic spinal cord injured patients.

    Science.gov (United States)

    Moviglia, G A; Varela, G; Brizuela, J A; Moviglia Brandolino, M T; Farina, P; Etchegaray, G; Piccone, S; Hirsch, J; Martinez, G; Marino, S; Deffain, S; Coria, N; Gonzáles, A; Sztanko, M; Salas-Zamora, P; Previgliano, I; Aingel, V; Farias, J; Gaeta, C A; Saslavsky, J; Blasseti, N

    2009-06-01

    With the intention to ameliorate the clinical condition of patients with chronic spinal cord injury (SCI), a program that combines three cell therapies and an appropriate neurorehabilitation program were used to recreate and enhance the natural conditions of SCI repair. Vascularization recovery is approached by selective artery infusion of BMMNCs (bone marrow mononuclear cells) to the disrupted area. Eighteen days later, with the aim to restore the specific inflammatory activity, an i.v. infusion of spinal cord specific ETCs (effector T cells) is carried out. With the intention of supplying cellular components for the process of repair, an infusion of autologous neural stem cells (NSCs) through selective feeding artery infusion is carried out, followed by an appropriate neurorehabilitation program. A total of eight ASIA (American Spinal Injury Association) A patients (five with jeopardized brachial plexus and three without) received the treatment. No severe adverse events was observed in any of the receptor patients: five patients evolved from ASIA A to ASIA D and regained the ability to stand up and, with varying effectiveness, to walk; two patients remained in the same condition, but exhibited motor and sensitive improvements; and one patient could not be evaluated. These reports suggest that the biological characteristics of acute SCI may be recreated in a comprehensive, safe and effective manner.

  15. Magnesium Therapy in Pre-eclampsia Prolongs Analgesia Following Spinal Anaesthesia with Fentanyl and Bupivacaine: An Observational Study

    Directory of Open Access Journals (Sweden)

    Tülay Özkan Seyhan

    2014-06-01

    Full Text Available Background: Magnesium has anti-nociceptive effects and potentiates opioid analgesia following its systemic and neuraxial administration. However, there is no study evaluating the effects of intravenous (IV magnesium sulphate (MgSO4 therapy on spinal anaesthesia characteristics in severely pre-eclamptic patients. Aims: The aim of this study was to compare spinal anaesthesia characteristics in severely pre-eclamptic parturients treated with MgSO4 and healthy preterm parturients undergoing caesarean section. Thus, our primary outcome was regarded as the time to first analgesic request following spinal anaesthesia. Study Design: Case-control Study. Methods: Following approval of Institutional Clinical Research Ethics Committee and informed consent of the patients, 44 parturients undergoing caesarean section with spinal anaesthesia were enrolled in the study in two groups: Healthy preterm parturients (Group C and severely pre-eclamptic parturients with IV MgSO4 therapy (Group Mg. Following blood and cerebrospinal fluid (CSF sampling, spinal anaesthesia was induced with 9 mg hyperbaric bupivacaine and 20 µg fentanyl. Serum and CSF magnesium levels, onset of sensory block at T4 level, highest sensory block level, motor block characteristics, time to first analgesic request, maternal haemodynamics as well as side effects were evaluated. Results: Blood and CSF magnesium levels were higher in Group Mg. Sensory block onset at T4 were 257.1±77.5 and 194.5±80.1 sec in Group C and Mg respectively (p=0.015. Time to first postoperative analgesic request was significantly prolonged in Group Mg than in Group C (246.1±52.8 and 137.4±30.5 min, respectively, p<0.001; with a mean difference of 108.6 min and 95% CI between 81.6 and 135.7. Side effects were similar in both groups. Group C required significantly more fluids. Conclusion: Treatment with IV MgSO4 in severe pre-eclamptic parturients significantly prolonged the time to first analgesic request compared

  16. Long-term potentiation in spinal nociceptive pathways as a novel target for pain therapy

    Directory of Open Access Journals (Sweden)

    Liu Xian-Guo

    2011-03-01

    Full Text Available Abstract Long-term potentiation (LTP in nociceptive spinal pathways shares several features with hyperalgesia and has been proposed to be a cellular mechanism of pain amplification in acute and chronic pain states. Spinal LTP is typically induced by noxious input and has therefore been hypothesized to contribute to acute postoperative pain and to forms of chronic pain that develop from an initial painful event, peripheral inflammation or neuropathy. Under this assumption, preventing LTP induction may help to prevent the development of exaggerated postoperative pain and reversing established LTP may help to treat patients who have an LTP component to their chronic pain. Spinal LTP is also induced by abrupt opioid withdrawal, making it a possible mechanism of some forms of opioid-induced hyperalgesia. Here, we give an overview of targets for preventing LTP induction and modifying established LTP as identified in animal studies. We discuss which of the various symptoms of human experimental and clinical pain may be manifestations of spinal LTP, review the pharmacology of these possible human LTP manifestations and compare it to the pharmacology of spinal LTP in rodents.

  17. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Life in a Wheelchair Lisa Rosen, MS Spasticity, Physical Therapy-Lokomat T. George Hornby, PhD, PT Empowering ... Rogers, SW Marguerite David, MSW Kathy Hulse, MSW Physical Therapy after Spinal Cord Injury Laura Wehrli, PT ...

  18. Safety of continuing aspirin therapy during spinal surgery: A systematic review and meta-analysis.

    Science.gov (United States)

    Zhang, Chenggui; Wang, Guodong; Liu, Xiaoyang; Li, Yang; Sun, Jianmin

    2017-11-01

    Questions whether to continue or discontinue aspirin administration in the perioperative period of spinal surgery has not been systematically evaluated. The present systematic review is carried out to assess the impact of continuing aspirin administration on the bleeding and cardiovascular events in perispinal surgery period. Studies were retrieved through MEDLINE, EMBASE, and Springer Link Databases (search terms, aspirin, continue or discontinue, and spinal fusion), bibliographies of the articles retrieved, and the authors' reference files. We included studies that enrolled patients who underwent spinal surgery who were anticoagulated with aspirin alone and that reported bleeding or cardiovascular events as an outcome. Study quality was assessed using a validated form. 95% confidence interval (95% CI) was pooled to give summary estimates of bleeding and cardiovascular risk. We identified 4 studies assessing bleeding risk associated with aspirin continuation or cardiovascular risk with aspirin discontinuation during spinal surgery. The continuation of aspirin will not increase the risk of blood loss during the spinal surgery (95% CI, -111.72 to -0.59; P = .05). Also, there was no observed increase in the operative time (95% CI, -33.29 to -3.89; P = .01) and postoperative blood transfusion (95% CI, 0.00-0.27; P = .05). But as for the cardiovascular risk without aspirin continuation and mean hospital length of stay with aspirin continuation, we did not get enough samples to make an accurate decision about their relations with aspirin. Patients undergoing spinal surgery with continued aspirin administration do not have an increased risk for bleeding. In addition, there is no observed increase in the operation time and postoperative blood transfusion.

  19. Spinal Cord Glioblastoma Induced by Radiation Therapy of Nasopharyngeal Rhabdomyosarcoma with MRI Findings: Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Se Jin; Kim, In One [Dept. of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2012-09-15

    Radiation-induced spinal cord gliomas are extremely rare. Since the first case was reported in 1980, only six additional cases have been reported.; The radiation-induced gliomas were related to the treatment of Hodgkin's lymphoma, thyroid cancer, and medullomyoblastoma, and to multiple chest fluoroscopic examinations in pulmonary tuberculosis patient. We report a case of radiation-induced spinal cord glioblastoma developed in a 17-year-old girl after a 13-year latency period following radiotherapy for nasopharyngeal rhabdomyosarcoma. MRI findings of our case are described.

  20. Optimization of low-level light therapy's illumination parameters for spinal cord injury in a rat model

    Science.gov (United States)

    Shuaib, Ali; Bourisly, Ali

    2018-02-01

    Spinal cord injury (SCI) can result in complete or partial loss of sensation and motor function due to interruption along the severed axonal tract(s). SCI can result in tetraplegia or paraplegia, which can have prohibitive lifetime medical costs and result in shorter life expectancy. A promising therapeutic technique that is currently in experimental phase and that has the potential to be used to treat SCI is Low-level light therapy (LLLT). Preclinical studies have shown that LLLT has reparative and regenerative capabilities on transected spinal cords, and that LLLT can enhance axonal sprouting in animal models. However, despite the promising effects of LLLT as a therapy for SCI, it remains difficult to compare published results due to the use of a wide range of illumination parameters (i.e. different wavelengths, fluences, beam types, and beam diameter), and due to the lack of a standardized experimental protocol(s). Before any clinical applications of LLLT for SCI treatment, it is crucial to standardize illumination parameters and efficacy of light delivery. Therefore, in this study we aim to evaluate the light fluence distribution on a 3D voxelated SCI rat model with different illumination parameters (wavelengths: 660, 810, and 980 nm; beam types: Gaussian and Flat; and beam diameters: 0.1, 0.2, and 0.3 cm) for LLLT using Monte Carlo simulation. This study provides an efficient approach to guide researchers in optimizing the illumination parameters for LLLT spinal cord injury in an experimental model and will aid in quantitative and qualitative standardization of LLLT-SCI treatment.

  1. Hybrid surgery-radiosurgery therapy for metastatic epidural spinal cord compression: A prospective evaluation using patient-reported outcomes.

    Science.gov (United States)

    Barzilai, Ori; Amato, Mary-Kate; McLaughlin, Lily; Reiner, Anne S; Ogilvie, Shahiba Q; Lis, Eric; Yamada, Yoshiya; Bilsky, Mark H; Laufer, Ilya

    2018-05-01

    Patient-reported outcomes (PRO) represent an important measure of cancer therapy effect. For patients with metastatic epidural spinal cord compression (MESCC), hybrid therapy using separation surgery and stereotactic radiosurgery preserves neurologic function and provides tumor control. There is currently a paucity of data reporting PRO after such combined modality therapy for MESCC. Delineation of hybrid surgery-radiosurgery therapy effect on PRO validates the hybrid approach as an effective therapy resulting in meaningful symptom relief. Brief Pain Inventory (BPI) and MD Anderson Symptom Inventory-Spine Tumor (MDASI-SP), PROs validated in the cancer population, were prospectively collected. Patients with MESCC who underwent separation surgery followed by stereotactic radiosurgery were included. Separation surgery included a posterolateral approach without extensive cytoreductive tumor excision. A median postoperative radiosurgery dose of 2700 cGy was delivered. The change in PRO 3 months after the hybrid therapy represented the primary study outcome. Preoperative and postoperative evaluations were analyzed using the Wilcoxon signed-rank test for matched pairs. One hundred eleven patients were included. Hybrid therapy resulted in a significant reduction in the BPI items "worst" and "right now" pain ( P < .0001), and in all BPI constructs (severity, interference with daily activities, and pain experience, P < .001). The MDASI-SP demonstrated reduction in spine-specific pain severity and interference with general activity ( P < .001), along with decreased symptom interference ( P < .001). Validated PRO instruments showed that in patients with MESCC, hybrid therapy with separation surgery and radiosurgery results in a significant decrease in pain severity and symptom interference. These prospective data confirm the benefit of hybrid therapy for treatment of MESCC and should facilitate referral of patients with MESCC for surgical evaluation.

  2. Detailed analysis of the clinical effects of cell therapy for thoracolumbar spinal cord injury: an original study

    Directory of Open Access Journals (Sweden)

    Sharma A

    2013-07-01

    Full Text Available Alok Sharma,1 Nandini Gokulchandran,1 Hemangi Sane,2 Prerna Badhe,1 Pooja Kulkarni,2 Mamta Lohia,3 Anjana Nagrajan,3 Nancy Thomas3 1Department of Medical Services and Clinical Research, 2Department of Research and Development, 3Department of Neurorehabilitation, NeuroGen Brain and Spine Institute, Surana Sethia Hospital and Research Centre, Chembur, Mumbai, India Background: Cell therapy is amongst the most promising treatment strategies in spinal cord injury (SCI because it focuses on repair. There are many published animal studies and a few human trials showing remarkable results with various cell types. The level of SCI determines whether paraplegia or quadriplegia is present, and greatly influences recovery. The purpose of this study was to determine the significance of the clinical effects and long-term safety of intrathecal administration of autologous bone marrow-derived mononuclear cells, along with changes in functional independence and quality of life in patients with thoracolumbar SCI. Methods: We undertook a retrospective analysis of a clinical study in which a nonrandomized sample of 110 patients with thoracolumbar SCI underwent autologous bone marrow-derived mononuclear cell transplantation intrathecally and subsequent neurorehabilitation, with a mean follow-up of 2 years ± 1 month. Changes on any parameters were recorded at follow-up. The data were analyzed using the Wilcoxon's signed-rank test and McNemar's test. Functional Independence Measure and American Spinal Injury Association (ASIA scores were recorded, and a detailed neurological assessment was performed. Results: Overall improvement was seen in 91% of patients, including reduction in spasticity, partial sensory recovery, and improvement in trunk control, postural hypotension, bladder management, mobility, activities of daily living, and functional independence. A significant association of these symptomatic improvements with the cell therapy intervention was established

  3. Activity-Based Restorative Therapies: Concepts and Applications in Spinal Cord Injury-Related Neurorehabilitation

    Science.gov (United States)

    Sadowsky, Cristina L.; McDonald, John W.

    2009-01-01

    Physical rehabilitation following spinal cord injury-related paralysis has traditionally focused on teaching compensatory techniques, thus enabling the individual to achieve day-to-day function despite significant neurological deficits. But the concept of an irreparable central nervous system (CNS) is slowly being replaced with evidence related to…

  4. Clinical Response of 277 Patients with Spinal Cord Injury to Stem Cell Therapy in Iraq

    Science.gov (United States)

    Hammadi, Abdulmajeed Alwan; Marino, Andolina; Farhan, Saad

    2012-01-01

    Background and Objectives: Spinal cord injury is a common neurological problem secondary to car accidents, war injuries and other causes, it may lead to varying degrees of neurological disablement, and apart from physiotherapy there is no available treatment to regain neurological function loss. Our aim is to find a new method using autologous hematopoietic stem cells to gain some of the neurologic functions lost after spinal cord injury. Methods and Results: 277 patients suffering from spinal cord injury were submitted to an intrathecally treatment with peripheral stem cells. The cells were harvested from the peripheral blood after a treatment with G-CSF and then concentrated to 4∼ 6 ml. 43% of the patients improved; ASIA score shifted from A to B in 88 and from A to C in 32. The best results were achieved in patients treated within one year from the injury. Conclusions: Since mesenchymal cells increase in the peripheral blood after G-CSF stimulation, a peripheral blood harvest seems easier and cheaper than mesenchymal cell cultivation prior to injection. It seems reasonable treatment for spinal cord injury. PMID:24298358

  5. Dual Differentiation-Exogenous Mesenchymal Stem Cell Therapy for Traumatic Spinal Cord Injury Repair in a Murine Hemisection Model

    Directory of Open Access Journals (Sweden)

    Hai Liu

    2013-01-01

    Full Text Available Mesenchymal stem cell (MSC transplantation has shown tremendous promise as a therapy for repair of various tissues of the musculoskeletal, vascular, and central nervous systems. Based on this success, recent research in this field has focused on complex tissue damage, such as that which occurs from traumatic spinal cord injury (TSCI. As the critical event for successful exogenous, MSC therapy is their migration to the injury site, which allows for their anti-inflammatory and morphogenic effects on fracture healing, neuronal regeneration, and functional recover. Thus, there is a need for a cost-effective in vivo model that can faithfully recapitulate the salient features of the injury, therapy, and recovery. To address this, we review the recent advances in exogenous MSC therapy for TSCI and traumatic vertebral fracture repair and the existing challenges regarding their translational applications. We also describe a novel murine model designed to take advantage of multidisciplinary collaborations between musculoskeletal and neuroscience researchers, which is needed to establish an efficacious MSC therapy for TSCI.

  6. Is refractory angina pectoris a form of chronic pain? A comparison of two patient groups receiving spinal cord stimulation therapy.

    Science.gov (United States)

    Pak, Nick; Devcich, Daniel A; Johnson, Malcolm H; Merry, Alan F

    2014-03-28

    To compare psychological and pain-related characteristics of patients with chronic pain and patients with refractory angina pectoris who had been treated with spinal cord stimulation (SCS) therapy. Twenty-four patients receiving SCS therapy were interviewed. Four psychological variables were assessed using standardised questionnaires for pain catastrophising, health locus of control, anxiety sensitivity, and self-efficacy. Patients also completed the revised version of the Short-Form McGill Pain Questionnaire, the Short-Form Health Survey, and self-reported measures of global perceived effect, pain, functionality, and satisfaction with SCS therapy. Most patients reported improvements in pain, functionality, and improvement overall. Some health locus of control dimensions were significantly higher for the angina group than the chronic pain group, and chronic angina patients reported significantly lower levels of intermittent pain. Virtually all patients reported being satisfied with SCS therapy. Most self-rated psychological and pain-related characteristics were no different between the two groups, which gives some support to the view that refractory angina is a form of chronic pain. The results also add to evidence supporting the use of SCS therapy for refractory angina pectoris; however, differences observed on a few variables may indicate points of focus for the assessment and treatment of such patients.

  7. Altering Conventional to High Density Spinal Cord Stimulation: An Energy Dose-Response Relationship in Neuropathic Pain Therapy.

    Science.gov (United States)

    Wille, Frank; Breel, Jennifer S; Bakker, Eric W P; Hollmann, Markus W

    2017-01-01

    To examine whether converting from conventional Spinal Cord Stimulation (SCS) to High Density (HD) SCS reduces neuropathic pain over a period of 12 months in patients with failed SCS therapy. Retrospective, open label, single center, consecutive case series of 30 neuropathic pain patients (Failed Back Surgery Syndrome [FBSS], Complex Regional Pain Syndrome [CRPS], and polyneuropathy [NP]). Patients with an initial adequate response to conventional SCS, but in whom pain increased over time, were included (Numeric Rating Scales [NRS] >6). These patients were stimulated with HD-SCS parameters and followed-up for 12 months. We report pain intensity, measured with NRS, before SCS implantation, 1 and 3 months after starting SCS with conventional stimulation, and after 1, 6, and 12 months of HD SCS. Pain reduction with conventional stimulation was initially adequate (NRS mean 8.6 to 5.3 at three months postimplant) but increased over time to a mean NRS of 7.7 at the time of reprogramming. NRS scores decreased significantly to 4.3 (p = 0.015) after reprogramming from conventional SCS (30 Hz, 300 µsec, 3.0 V) to HD SCS (409 Hz, range 130-1000 Hz, 409 µsec, 2.4V) in the patients still using HD-SCS at 12 months. In the nonresponders (patients who stopped HD-SCS for any reason), 76% had a diagnosis of FBSS. Almost half of the patients aborting HD-SCS preferred to feel paresthesias despite better pain relief. There was a significant difference between nonresponders and responders regarding the amount of electrical energy delivered to the spinal cord. Neuropathic pain suppression is significantly enhanced after converting from failed conventional SCS to HD SCS in patients with FBSS, CRPS, and NP over a measured period of 12 months. There appears to be a dose-related response between the amount of energy delivered to the spinal cord and clinical effect. © 2016 International Neuromodulation Society.

  8. Directing Spinal Cord Plasticity: The Impact of Stretch Therapy on Functional Recovery After SCI

    Science.gov (United States)

    2017-03-01

    Grand Rounds, University of Louisville. October 8, 2015 Of Mice and Men: The bench to bedside efforts to improve the quality of life of people with...Charts: Please see attached QUAD chart. Appendices: Please see links above to published journal articles . Appendices 1-4 to follow. Directing Spinal...represents the mean peak extension and flexion, respectively, of the joint angles – standard deviation, and thus bar length represents the mean angular

  9. Direct manipulation of physiological arousal in induced anxiety therapy - biofeedback approach.

    Science.gov (United States)

    Sappington, A A

    1977-10-01

    This study investigated the role of physiological arousal in the affect induction phase of Induced Anxiety therapy by using biofeedback to facilitate arousal. Twenty-one college students who were suffering from free-floating anxiety were assigned randomly to one of three groups: (1) a no-treatment control group simply completed the measures before and after therapy; (2) a conventional Induced Anxiety group went through five standard Induced Anxiety sessions; and (3) biofeedback Induced Anxiety group went through a similar procedure except that biofeedback was used in the affect induction phase to facilitate heart rate increase. It was found that the biofeedback procedure did result in a greater heart rate increase during the affect induction phase arousal than did the conventional procedure (.01 level of significance), but did not facilitate subjective emotional arousal. Biofeedback Induced Anxiety resulted in a greater reduction of trait anxiety as measured by the Multiple Affect Adjective Check List than did the no-treatment group or the conventonal Induced Anxiety group. The conventional Induced Anxiety group did not differ significantly from the no-treatment control group.

  10. How effective are spiritual care and body manipulation therapies in pediatric oncology? A systematic review of the literature.

    Science.gov (United States)

    Poder, Thomas G; Lemieux, Renald

    2013-12-10

    The effects of cancer and associated treatments have a considerable impact on the well-being and quality of life of pediatric oncology patients. To support children and their families, complementary and alternative medicines are seen by nurses and doctors as practical to integrate to the services offered by hospitals. The purpose of this paper is to examine if the practice of complementary and alternative medicine, specifically spiritual care and treatments based on body manipulation, is likely to improve the health and well-being of children suffering from cancer. This objective is achieved through a systematic review of the literature. The level of evidence associated with each practice of complementary and alternative medicine was assessed according to the methodological design used by the studies reviewed. Studies reviewed are of a methodological quality that could be described as fair due to the small sample size of patients and the existence of a number of biases in the conduct and analysis of these studies. However, results obtained are consistent from one study to another, allowing us to make certain recommendations. It is thus advisable to consider the introduction of hypnotherapy in pediatric oncology services. Based on the data collected, it is the complementary and alternative medicine with the most evidence in favor of effectiveness of the well-being of pediatric oncology patients, especially during painful procedures. It is also recommended to use art therapy and music therapy. Conversely, too little evidence is present to be able to recommend the use of acupuncture, chiropractic or osteopathy.

  11. Association of antidepressant medication therapy with inpatient rehabilitation outcomes for stroke, traumatic brain injury, or traumatic spinal cord injury.

    Science.gov (United States)

    Weeks, Douglas L; Greer, Christopher L; Bray, Brenda S; Schwartz, Catrina R; White, John R

    2011-05-01

    To study whether outcomes in patients who have undergone inpatient rehabilitation for stroke, traumatic brain injury (TBI), or traumatic spinal cord injury (TSCI) differ based on antidepressant medication (ADM) use. Retrospective cohort study of 867 electronic medical records of patients receiving inpatient rehabilitation for stroke, TBI, or TSCI. Four cohorts were formed within each rehabilitation condition: patients with no history of ADM use and no indication of history of depression; patients with no history of ADM use but with a secondary diagnostic code for a depressive illness; patients with a history of ADM use prior to and during inpatient rehabilitation; and patients who began ADM therapy in inpatient rehabilitation. Freestanding inpatient rehabilitation facility (IRF). Patients diagnosed with stroke (n=625), TBI (n=175), and TSCI (n=67). Not applicable. FIM, rehabilitation length of stay (LOS), deviation between actual LOS and expected LOS, and functional gain per day. In each impairment condition, patients initiating ADM therapy in inpatient rehabilitation had longer LOS than patients in the same impairment condition on ADM at IRF admission, and had significantly longer LOS than patients with no history of ADM use and no diagnosis of depression (Pstroke and TBI groups initiating ADM in IRF than their counterparts with no history of ADM use, illustrating that the group initiating ADM therapy in rehabilitation significantly exceeded expected LOS. Increased LOS did not translate into functional gains, and in fact, functional gain per day was lower in the group initiating ADM therapy in IRF. Explanations for unexpectedly long LOS in patients initiating ADM in inpatient rehabilitation focus on the potential for ADM to inhibit therapy-driven remodeling of the nervous system when initiated close in time to nervous system injury, or the possibility that untreated sequelae (eg, depressive symptoms or fatigue) were limiting progress in therapy, which triggered

  12. Use of electronic music as an occupational therapy modality in spinal cord injury rehabilitation: an occupational performance model.

    Science.gov (United States)

    Lee, B; Nantais, T

    1996-05-01

    This article describes an electronic music program that allows clients with spinal cord injury (SCI) to form musical bands and play songs while performing therapeutic exercise in an occupational therapy program. Clients create the music by activating upper extremity exercise devices that are connected to a synthesizer through a computer. The bands choose the songs they would like to play and meet twice a week for 1 hr to practice. The 8-week program often concludes with a public performance. The music program is intended to motivate client participation in physical rehabilitation while promoting self-esteem, emotional expression, and peer support. It is based on the model of occupational performance and the theory of purposeful activity. To date, 33 persons have taken part. Client, therapist, and public response has been positive because this program highlights the abilities of persons with SCI, thereby encouraging their reintegration into the community.

  13. Potential role of proton therapy in the treatment of pediatric medulloblastoma/primitive neuro-ectodermal tumors: spinal theca irradiation

    International Nuclear Information System (INIS)

    Miralbell, Raymond; Lomax, Anthony; Russo, Mariateresa

    1997-01-01

    Purpose: Conventional postoperative photon-beam radiotherapy to the spine in children with medulloblastoma/PNET is associated with severe late effects. This morbidity (growth and developmental) is related to the exit dose of the beams and is particularly severe in young children. With the purpose of reducing this toxicity, a dosimetric study was undertaken in which proton therapy was compared to standard megavoltage photon treatment. Methods and materials: The results of a comparative dosimetric study are presented in such a way that the dose distribution achievable with a posterior modulated 100 MeV proton beam (spot scanning method) is compared with that of a standard set of posterior 6 MV x-ray fields. The potential improvements with protons are evaluated, using dose-volume histograms to examine the coverage of the target as well as the dose to the vertebral bodies (growth plates), lungs, heart, and liver. Results: The target (i.e., the spinal dural sac) received the full prescribed dose in both treatment plans. However, the proportions of the vertebral body volume receiving ≥50% of the prescribed dose were 100 and 20% for 6 MV x-rays and protons, respectively. For 6 MV x-rays >60% of the dose prescribed to the target was delivered to 44% of the heart volume, while the proton beam was able to completely avoid the heart, the liver, and in all likelihood the thyroid and gonads as well. Conclusion: The present study demonstrates a potential role of proton therapy in decreasing the dose (and toxicity) to the critical structures in the irradiation of the spinal neuraxis in medulloblastoma/PNET. The potential bone marrow and growth arrest sparing effects make this approach specially attractive for intensive chemotherapy protocols and for very young children. Sparing the thyroid gland, the posterior heart wall, and the gonads may be additional advantages in assuring a long-term posttreatment morbidity-free survival

  14. Near-Infrared-Light-Responsive Magnetic DNA Microgels for Photon- and Magneto-Manipulated Cancer Therapy.

    Science.gov (United States)

    Wang, Yitong; Wang, Ling; Yan, Miaomiao; Dong, Shuli; Hao, Jingcheng

    2017-08-30

    Functional DNA molecules have been introduced into polymer-based nanocarrier systems to incorporate chemotherapy drugs for cancer therapy. Here is the first report of dual-responsive microgels composed of a core of Au nanorods and a shell of magnetic ionic liquid and DNA moieties in the cross-linking network simultaneously, as effective drug delivery vectors. TEM images indicated a magnetic polymer shell has an analogous "doughnut" shape which loosely surround the AuNRs core. When irradiated with a near-infrared-light (near-IR) laser, Au nanorods are the motors which convert the light to heat, leading to the release of the encapsulated payloads with high controllability. DNA acts not only as a cross-linker agent, but also as a gatekeeper to regulate the release of drugs. The internalization study and MTT assay confirm that these core-shell DNA microgels are excellent candidates which can enhance the cytotoxicity of cancer cells controlled by near-IR laser and shield the high toxicity of chemotherapeutic agents to improve the killing efficacy of chemotherapeutic agents efficiently in due course.

  15. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... arrow What are the latest developments in the use of electrical stimulation for spinal cord injuries? play_arrow What is “Braingate” research? play_arrow How would stem-cell therapies work in the treatment of spinal cord ...

  16. Computed tomography of the spinal canal for the cervical spine and spinal cord injury

    International Nuclear Information System (INIS)

    Kimura, Isao; Niimiya, Hikosuke; Nasu, Kichiro; Shioya, Akihide; Ohhama, Mitsuru

    1983-01-01

    The cervical spinal canal and cervical spinal cord were measured in normal cases and 34 cases of spinal or spinal cord injury. The anteroposterior diameter and area of the normal cervical spinal canal showed a high correlation. The area ratio of the normal cervical spinal canal to the cervical spinal cord showed that the proportion of the cervical spinal cord in the spinal canal was 1/3 - 1/5, Csub(4,5) showing a particularly large proportion. In acute and subacute spinal or spinal cord injury, CT visualized in more details of the spinal canal in cases that x-ray showed definite bone injuries. Computer assisted myelography visualized more clearly the condition of the spinal cord in cases without definite findings bone injuries on x-ray. Demonstrating the morphology of spinal injury in more details, CT is useful for selection of therapy for injured spines. (Chiba, N.)

  17. Sensitivity of 3D Dose Verification to Multileaf Collimator Misalignments in Stereotactic Body Radiation Therapy of Spinal Tumor.

    Science.gov (United States)

    Xin-Ye, Ni; Ren, Lei; Yan, Hui; Yin, Fang-Fang

    2016-12-01

    This study aimed to detect the sensitivity of Delt 4 on ordinary field multileaf collimator misalignments, system misalignments, random misalignments, and misalignments caused by gravity of the multileaf collimator in stereotactic body radiation therapy. (1) Two field sizes, including 2.00 cm (X) × 6.00 cm (Y) and 7.00 cm (X) × 6.00 cm (Y), were set. The leaves of X1 and X2 in the multileaf collimator were simultaneously opened. (2) Three cases of stereotactic body radiation therapy of spinal tumor were used. The dose of the planning target volume was 1800 cGy with 3 fractions. The 4 types to be simulated included (1) the leaves of X1 and X2 in the multileaf collimator were simultaneously opened, (2) only X1 of the multileaf collimator and the unilateral leaf were opened, (3) the leaves of X1 and X2 in the multileaf collimator were randomly opened, and (4) gravity effect was simulated. The leaves of X1 and X2 in the multileaf collimator shifted to the same direction. The difference between the corresponding 3-dimensional dose distribution measured by Delt 4 and the dose distribution in the original plan made in the treatment planning system was analyzed with γ index criteria of 3.0 mm/3.0%, 2.5 mm/2.5%, 2.0 mm/2.0%, 2.5 mm/1.5%, and 1.0 mm/1.0%. (1) In the field size of 2.00 cm (X) × 6.00 cm (Y), the γ pass rate of the original was 100% with 2.5 mm/2.5% as the statistical standard. The pass rate decreased to 95.9% and 89.4% when the X1 and X2 directions of the multileaf collimator were opened within 0.3 and 0.5 mm, respectively. In the field size of 7.00 (X) cm × 6.00 (Y) cm with 1.5 mm/1.5% as the statistical standard, the pass rate of the original was 96.5%. After X1 and X2 of the multileaf collimator were opened within 0.3 mm, the pass rate decreased to lower than 95%. The pass rate was higher than 90% within the 3 mm opening. (2) For spinal tumor, the change in the planning target volume V 18 under various modes calculated using treatment planning system

  18. Dosimetric evaluation of 4 different treatment modalities for curative-intent stereotactic body radiation therapy for isolated thoracic spinal metastases

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Jun [Department of Radiation Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 (China); Department of Oncology, First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Weihui, Henan, 453100 (China); Ma, Lin [Department of Radiation Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 (China); Department of Radiation Oncology, Hainan Branch of Chinese PLA General Hospital, Haitang Bay, Sanya, 572000 (China); Wang, Xiao-Shen; Xu, Wei Xu; Cong, Xiao-Hu; Xu, Shou-Ping; Ju, Zhong-Jian [Department of Radiation Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 (China); Du, Lei [Department of Radiation Oncology, Hainan Branch of Chinese PLA General Hospital, Haitang Bay, Sanya, 572000 (China); Cai, Bo-Ning [Department of Radiation Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 (China); Yang, Jack [Department of Radiation Oncology, Monmouth Medical Center, 300 2nd Avenue, Long Branch, NJ 07740 (United States)

    2016-07-01

    To investigate the dosimetric characteristics of 4 SBRT-capable dose delivery systems, CyberKnife (CK), Helical TomoTherapy (HT), Volumetric Modulated Arc Therapy (VMAT) by Varian RapidArc (RA), and segmental step-and-shoot intensity-modulated radiation therapy (IMRT) by Elekta, on isolated thoracic spinal lesions. CK, HT, RA, and IMRT planning were performed simultaneously for 10 randomly selected patients with 6 body types and 6 body + pedicle types with isolated thoracic lesions. The prescription was set with curative intent and dose of either 33 Gy in 3 fractions (3F) or 40 Gy in 5F to cover at least 90% of the planning target volume (PTV), correspondingly. Different dosimetric indices, beam-on time, and monitor units (MUs) were evaluated to compare the advantages/disadvantages of each delivery modality. In ensuring the dose-volume constraints for cord and esophagus of the premise, CK, HT, and RA all achieved a sharp conformity index (CI) and a small penumbra volume compared to IMRT. RA achieved a CI comparable to those from CK, HT, and IMRT. CK had a heterogeneous dose distribution in the target as its radiosurgical nature with less dose uniformity inside the target. CK had the longest beam-on time and the largest MUs, followed by HT and RA. IMRT presented the shortest beam-on time and the least MUs delivery. For the body-type lesions, CK, HT, and RA satisfied the target coverage criterion in 6 cases, but the criterion was satisfied in only 3 (50%) cases with the IMRT technique. For the body + pedicle-type lesions, HT satisfied the criterion of the target coverage of ≥90% in 4 of the 6 cases, and reached a target coverage of 89.0% in another case. However, the criterion of the target coverage of ≥90% was reached in 2 cases by CK and RA, and only in 1 case by IMRT. For curative-intent SBRT of isolated thoracic spinal lesions, RA is the first choice for the body-type lesions owing to its delivery efficiency (time); the second choice is CK or HT; HT is the

  19. Dosimetric evaluation of 4 different treatment modalities for curative-intent stereotactic body radiation therapy for isolated thoracic spinal metastases

    International Nuclear Information System (INIS)

    Yang, Jun; Ma, Lin; Wang, Xiao-Shen; Xu, Wei Xu; Cong, Xiao-Hu; Xu, Shou-Ping; Ju, Zhong-Jian; Du, Lei; Cai, Bo-Ning; Yang, Jack

    2016-01-01

    To investigate the dosimetric characteristics of 4 SBRT-capable dose delivery systems, CyberKnife (CK), Helical TomoTherapy (HT), Volumetric Modulated Arc Therapy (VMAT) by Varian RapidArc (RA), and segmental step-and-shoot intensity-modulated radiation therapy (IMRT) by Elekta, on isolated thoracic spinal lesions. CK, HT, RA, and IMRT planning were performed simultaneously for 10 randomly selected patients with 6 body types and 6 body + pedicle types with isolated thoracic lesions. The prescription was set with curative intent and dose of either 33 Gy in 3 fractions (3F) or 40 Gy in 5F to cover at least 90% of the planning target volume (PTV), correspondingly. Different dosimetric indices, beam-on time, and monitor units (MUs) were evaluated to compare the advantages/disadvantages of each delivery modality. In ensuring the dose-volume constraints for cord and esophagus of the premise, CK, HT, and RA all achieved a sharp conformity index (CI) and a small penumbra volume compared to IMRT. RA achieved a CI comparable to those from CK, HT, and IMRT. CK had a heterogeneous dose distribution in the target as its radiosurgical nature with less dose uniformity inside the target. CK had the longest beam-on time and the largest MUs, followed by HT and RA. IMRT presented the shortest beam-on time and the least MUs delivery. For the body-type lesions, CK, HT, and RA satisfied the target coverage criterion in 6 cases, but the criterion was satisfied in only 3 (50%) cases with the IMRT technique. For the body + pedicle-type lesions, HT satisfied the criterion of the target coverage of ≥90% in 4 of the 6 cases, and reached a target coverage of 89.0% in another case. However, the criterion of the target coverage of ≥90% was reached in 2 cases by CK and RA, and only in 1 case by IMRT. For curative-intent SBRT of isolated thoracic spinal lesions, RA is the first choice for the body-type lesions owing to its delivery efficiency (time); the second choice is CK or HT; HT is the

  20. PDE 7 inhibitors: new potential drugs for the therapy of spinal cord injury.

    Directory of Open Access Journals (Sweden)

    Irene Paterniti

    Full Text Available BACKGROUND: Primary traumatic mechanical injury to the spinal cord (SCI causes the death of a number of neurons that to date can neither be recovered nor regenerated. During the last years our group has been involved in the design, synthesis and evaluation of PDE7 inhibitors as new innovative drugs for several neurological disorders. Our working hypothesis is based on two different facts. Firstly, neuroinflammation is modulated by cAMP levels, thus the key role for phosphodiesterases (PDEs, which hydrolyze cAMP, is undoubtedly demonstrated. On the other hand, PDE7 is expressed simultaneously on leukocytes and on the brain, highlighting the potential crucial role of PDE7 as drug target for neuroinflammation. METHODOLOGY/PRINCIPAL FINDINGS: Here we present two chemically diverse families of PDE7 inhibitors, designed using computational techniques such as virtual screening and neuronal networks. We report their biological profile and their efficacy in an experimental SCI model induced by the application of vascular clips (force of 24 g to the dura via a four-level T5-T8 laminectomy. We have selected two candidates, namely S14 and VP1.15, as PDE7 inhibitors. These compounds increase cAMP production both in macrophage and neuronal cell lines. Regarding drug-like properties, compounds were able to cross the blood brain barrier using parallel artificial membranes (PAMPA methodology. SCI in mice resulted in severe trauma characterized by edema, neutrophil infiltration, and production of a range of inflammatory mediators, tissue damage, and apoptosis. Treatment of the mice with S14 and VP1.15, two PDE7 inhibitors, significantly reduced the degree of spinal cord inflammation, tissue injury (histological score, and TNF-α, IL-6, COX-2 and iNOS expression. CONCLUSIONS/SIGNIFICANCE: All these data together led us to propose PDE7 inhibitors, and specifically S14 and VP1.15, as potential drug candidates to be further studied for the treatment of SCI.

  1. ROCK inhibition as a therapy for spinal muscular atrophy: understanding the repercussions on multiple cellular targets

    Science.gov (United States)

    Coque, Emmanuelle; Raoul, Cédric; Bowerman, Mélissa

    2014-01-01

    Spinal muscular atrophy (SMA) is the most common genetic disease causing infant death, due to an extended loss of motoneurons. This neuromuscular disorder results from deletions and/or mutations within the Survival Motor Neuron 1 (SMN1) gene, leading to a pathological decreased expression of functional full-length SMN protein. Emerging studies suggest that the small GTPase RhoA and its major downstream effector Rho kinase (ROCK), which both play an instrumental role in cytoskeleton organization, contribute to the pathology of motoneuron diseases. Indeed, an enhanced activation of RhoA and ROCK has been reported in the spinal cord of an SMA mouse model. Moreover, the treatment of SMA mice with ROCK inhibitors leads to an increased lifespan as well as improved skeletal muscle and neuromuscular junction pathology, without preventing motoneuron degeneration. Although motoneurons are the primary target in SMA, an increasing number of reports show that other cell types inside and outside the central nervous system contribute to SMA pathogenesis. As administration of ROCK inhibitors to SMA mice was systemic, the improvement in survival and phenotype could therefore be attributed to specific effects on motoneurons and/or on other non-neuronal cell types. In the present review, we will present the various roles of the RhoA/ROCK pathway in several SMA cellular targets including neurons, myoblasts, glial cells, cardiomyocytes and pancreatic cells as well as discuss how ROCK inhibition may ameliorate their health and function. It is most likely a concerted influence of ROCK modulation on all these cell types that ultimately lead to the observed benefits of pharmacological ROCK inhibition in SMA mice. PMID:25221469

  2. ROCK inhibition as a therapy for spinal muscular atrophy: understanding the repercussions on multiple cellular targets

    Directory of Open Access Journals (Sweden)

    Emmanuelle eCoque

    2014-08-01

    Full Text Available Spinal muscular atrophy (SMA is the most common genetic disease causing infant death, due to an extended loss of motoneurons. This neuromuscular disorder results from deletions and/or mutations within the surviving motor neuron 1 (SMN1 gene, leading to a pathological decreased expression of functional full-length SMN protein. Emerging studies suggest that the small GTPase RhoA and its major downstream effector Rho kinase (ROCK, which both play an instrumental role in cytoskeleton organization, contribute to the pathology of motoneuron diseases. Indeed, an enhanced activation of RhoA and ROCK has been reported in the spinal cord of an SMA mouse model. Moreover, the treatment of SMA mice with ROCK inhibitors leads to an increased lifespan as well as improved skeletal muscle and neuromuscular junction pathology, without preventing motoneuron degeneration. Although motoneurons are the primary target in SMA, an increasing number of reports show that other cell types inside and outside the central nervous system contribute to SMA pathogenesis. As administration of ROCK inhibitors to SMA mice was systemic, the improvement in survival and phenotype could therefore be attributed to specific effects on motoneurons and/or on other non-neuronal cell types. In the present review, we will present the various roles of the RhoA/ROCK pathway in several SMA cellular targets including neurons, myocytes, glial cells, cardiomyocytes and pancreatic cells as well as discuss how ROCK inhibition may ameliorate their health and function. It is most likely a concerted influence of ROCK modulation on all these cell types that ultimately lead to the observed benefits of pharmacological ROCK inhibition in SMA mice.

  3. Spinal Cord Stimulation for Treating Chronic Pain: Reviewing Preclinical and Clinical Data on Paresthesia-Free High-Frequency Therapy.

    Science.gov (United States)

    Chakravarthy, Krishnan; Richter, Hira; Christo, Paul J; Williams, Kayode; Guan, Yun

    2018-01-01

    Traditional spinal cord stimulation (SCS) requires that paresthesia overlaps chronic painful areas. However, the new paradigm high-frequency SCS (HF-SCS) does not rely on paresthesia. A review of preclinical and clinical studies regarding the use of paresthesia-free HF-SCS for various chronic pain states. We reviewed available literatures on HF-SCS, including Nevro's paresthesia-free ultra high-frequency 10 kHz therapy (HF10-SCS). Data sources included relevant literature identified through searches of PubMed, MEDLINE/OVID, and SCOPUS, and manual searches of the bibliographies of known primary and review articles. The primary goal is to describe the present developing conceptions of preclinical mechanisms of HF-SCS and to review clinical efficacy on paresthesia-free HF10-SCS for various chronic pain states. HF10-SCS offers a novel pain reduction tool without paresthesia for failed back surgery syndrome and chronic axial back pain. Preclinical findings indicate that potential mechanisms of action for paresthesia-free HF-SCS differ from those of traditional SCS. To fully understand and utilize paresthesia-free HF-SCS, mechanistic study and translational research will be very important, with increasing collaboration between basic science and clinical communities to design better trials and optimize the therapy based on mechanistic findings from effective preclinical models and approaches. Future research in these vital areas may include preclinical and clinical components conducted in parallel to optimize the potential of this technology. © 2017 International Neuromodulation Society.

  4. Therapy of spinal wound infections using vacuum-assisted wound closure: risk factors leading to resistance to treatment.

    Science.gov (United States)

    Ploumis, Avraam; Mehbod, Amir A; Dressel, Thomas D; Dykes, Daryll C; Transfeldt, Ensor E; Lonstein, John E

    2008-07-01

    wound within the first 6 weeks postoperatively. Sixty-nine infections (87.3%) were deep below the fascia. There was no statistical significance (P>0.05) of all tested risk factors for the resistance of infection to treatment with the VAC system. The parameter more related to repeat VAC procedures was the culture of MRSA or multiple bacteria. VAC therapy may be an effective adjunct in closing spinal wounds even after the repeat procedures. The MRSA or multibacterial infections seem to be most likely to need repeat debridements and VAC treatment before final wound closure.

  5. Chitosan scaffolds induce human dental pulp stem cells to neural differentiation: potential roles for spinal cord injury therapy.

    Science.gov (United States)

    Zhang, Jinlong; Lu, Xiaohui; Feng, Guijuan; Gu, Zhifeng; Sun, Yuyu; Bao, Guofeng; Xu, Guanhua; Lu, Yuanzhou; Chen, Jiajia; Xu, Lingfeng; Feng, Xingmei; Cui, Zhiming

    2016-10-01

    Cell-based transplantation strategies hold great potential for spinal cord injury (SCI) repair. Chitosan scaffolds have therapeutic benefits for spinal cord regeneration. Human dental pulp stem cells (DPSCs) are abundant available stem cells with low immunological incompatibility and can be considered for cell replacement therapy. The purpose of this study is to investigate the role of chitosan scaffolds in the neural differentiation of DPSCs in vitro and to assess the supportive effects of chitosan scaffolds in an animal model of SCI. DPSCs were incubated with chitosan scaffolds. Cell viability and the secretion of neurotrophic factors were analyzed. DPSCs incubated with chitosan scaffolds were treated with neural differentiation medium for 14 days and then neural genes and protein markers were analyzed by Western blot and reverse transcription plus the polymerase chain reaction. Our study revealed a higher cell viability and neural differentiation in the DPSC/chitosan-scaffold group. Compared with the control group, the levels of BDNF, GDNF, b-NGF, and NT-3 were significantly increased in the DPSC/chitosan-scaffold group. The Wnt/β-catenin signaling pathway played a key role in the neural differentiation of DPSCs combined with chitosan scaffolds. Transplantation of DPSCs together with chitosan scaffolds into an SCI rat model resulted in the marked recovery of hind limb locomotor functions. Thus, chitosan scaffolds were non-cytotoxic and provided a conducive and favorable microenvironment for the survival and neural differentiation of DPSCs. Transplantation of DPSCs might therefore be a suitable candidate for treating SCI and other neuronal degenerative diseases.

  6. Feasibility of a classification system for physical therapy, occupational therapy, and sports therapy interventions for mobility and self-care in spinal cord injury rehabilitation

    NARCIS (Netherlands)

    van Langeveld, Sacha A.; Post, Marcel W.; van Asbeck, Floris W.; Postma, Karin; Leenders, Jacqueline; Pons, Kees

    Objective: To test the feasibility of a classification system developed to record the contents of treatment sessions intended to improve mobility and self-care by persons with a spinal cord injury (SCI) in clinical rehabilitation. Design: Descriptive study. Setting: Three Dutch SCI facilities.

  7. What do patients value about spinal manipulation and home exercise for back-related leg pain? A qualitative study within a controlled clinical trial

    DEFF Research Database (Denmark)

    Maiers, M.; Hondras, M. A.; Salsbury, S. A.

    2016-01-01

    contributors to both their satisfaction and the worthwhile nature of treatment. HEA was liked for its convenience and ability to foster an exercise habit. SMT was liked for specific aspects of the modality (e.g. manipulation, stretching) and provider competency. Most participants reported no dislikes for SMT...... exercise with advice (HEA). Design Qualitative study in a controlled clinical trial. Method Semi-structured interviews conducted after 12 weeks of treatment asked participants about satisfaction with care and whether treatment was worthwhile. An interdisciplinary research team conducted content analysis...

  8. Conservative care with or without manipulative therapy in the management of back and neck pain in Danish children aged 9-15

    DEFF Research Database (Denmark)

    Dissing, Kristina Boe; Hartvigsen, Jan; Wedderkopp, Niels

    is nested in the CHAMPS Study, which includes around 1200 children aged 9-15, who were all invited to participate in this randomized controlled trial in case they experienced back and/or neck pain during the two year inclusion period. Parents received text messages (SMS) on a weekly basis inquiring about......Background Complaints in the musculoskeletal system often start early in life and back and neck pain in children are well-established predictors for similar problems in adulthood. Despite lack of evidence of effectiveness, manipulative therapy is one of the most commonly used treatment modalities...... for back and neck pain in children. The primary objective of this study is to evaluate the effectiveness of manipulative therapy when added to an approach consisting of manual soft tissue treatment, exercises and advice as needed, in children aged 9-15 complaining of back and neck pain. Method The project...

  9. Conservative care with or without manipulative therapy in the management of back and neck pain in Danish children aged 9-15

    DEFF Research Database (Denmark)

    Dissing, Kristina Boe; Hartvigsen, Jan; Wedderkopp, Niels

    2016-01-01

    is nested in the Childhood Health, Activity and Motor Performance School Study, which includes around 1200 children aged 9-15, who were all invited to participate in this randomized controlled trial in case they experienced back and/or neck pain during the two year inclusion period. Parents received text......BACKGROUND: Complaints in the musculoskeletal system often start early in life and back and neck pain in children are well-established predictors for similar problems in adulthood. Despite lack of evidence of effectiveness, manipulative therapy is one of the most commonly used treatment modalities...... for back and neck pain in children. The primary objective of this study is to evaluate the effectiveness of manipulative therapy when added to an approach consisting of manual soft tissue treatment, exercises and advice as needed, in children aged 9-15 complaining of back and neck pain. METHOD: The project...

  10. Chronic Spinal Injury Repair by Olfactory Bulb Ensheathing Glia and Feasibility for Autologous Therapy

    Science.gov (United States)

    Muñoz-Quiles, Cintia; Santos-Benito, Fernando F.; Llamusí, M. Beatriz; Ramón-Cueto, Almudena

    2009-01-01

    Olfactory bulb ensheathing glia (OB-OEG) promote repair of spinal cord injury (SCI) in rats after transplantation at acute or subacute (up to 45 days) stages. The most relevant clinical scenario in humans, however, is chronic SCI, in which no more major cellular or molecular changes occur at the injury site; this occurs after the third month in rodents. Whether adult OB-OEG grafts promote repair of severe chronic SCI has not been previously addressed. Rats with complete SCI that were transplanted with OB-OEG 4 months after injury exhibited progressive improvement in motor function and axonal regeneration from different brainstem nuclei across and beyond the SCI site. A positive correlation between motor outcome and axonal regeneration suggested a role for brainstem neurons in the recovery. Functional and histological outcomes did not differ at subacute or chronic stages. Thus, autologous transplantation is a feasible approach as there is time for patient stabilization and OEG preparation in human chronic SCI; the healing effects of OB-OEG on established injuries may offer new therapeutic opportunities for chronic SCI patients. PMID:19915486

  11. Dependent Prior: An Application in Spinal Anaesthesia Drug Therapy on SBP in Cesarean patients.

    Directory of Open Access Journals (Sweden)

    Atanu Bhattacharjee

    2013-12-01

    Full Text Available Cesarean section is widely used operation procedure in the world. The regional anesthesia is preferred than general anesthesia. The risk of fetus is higher in general than in regional anesthesia. The drug treatment effect on regional anesthesia plays an important role to control the systolic blood pressure (SBP during the surgery. The goal of this work is to know the effective drug to control the SBP among cesarean anesthetic patients. The dependent prior with Bayesian approach is applied in the binary response data set. The secondary data in anesthesia has been applied to compare the two drug treatments, viz. (1 Phenylephrine and (2 Ephedrine, in cesarean patients with spinal anesthesia. In both drug groups the mean of SBP has been found controlled over the duration of the surgery. No rapid changes of SBP level among the patients are observed. At the end of study it is found that the means of SBP cesarean anesthetic patients are found higher in Phenylephrine group. The Bayesian dependent prior is found to offer effective tool for drug treatment effect comparison. The drug treatment effect Ephedrine is found to be more effective to control the SBP over the duration of surgery than Phenylephrine.

  12. Systematic review of induced pluripotent stem cell technology as a potential clinical therapy for spinal cord injury.

    Science.gov (United States)

    Kramer, Anne S; Harvey, Alan R; Plant, Giles W; Hodgetts, Stuart I

    2013-01-01

    importance of balancing the promise of this transplantation candidate in the light of these emerging properties is crucial as the potential application in the clinical setting approaches. The first of three sections in this review discusses (A) the pathophysiology of spinal cord injury (SCI) and how stem cell therapies can positively alter the pathology in experimental SCI. Part B summarizes (i) the available technologies to deliver transgenes to generate iPSCs and (ii) recent data comparing iPSCs to ESCs in terms of characteristics and molecular composition. Lastly, in (C) we evaluate iPSC-based therapies as a candidate to treat SCI on the basis of their neurite induction capability compared to embryonic stem cells and provide a summary of available in vivo data of iPSCs used in SCI and other disease models.

  13. Long-term effects of localized spinal radiation therapy on vertebral fractures and focal lesions appearance in patients with multiple myeloma

    International Nuclear Information System (INIS)

    Lecouvet, Frederic; Richard, Francoise; Berg, B. Vande; Malghem, Jacques; Maldague, Baudouin; Ferrant, Augustin; Michaux, J.-L.

    1997-01-01

    The occurrence of new vertebral fractures and focal marrow lesions was determined and compared in irradiated and nonirradiated vertebrae of 12 patients with multiple myeloma (MM), prospectively followed using magnetic resonance imaging (MRI) of the thoraco-lumbar spine after localized spinal radiation therapy. During follow-up (mean 35 months), fractures appeared in 5% of irradiated vertebrae and in 20% of nonirradiated vertebrae; new focal lesions appeared in 4% of irradiated vertebrae and in 27% of nonirradiated vertebrae. This study demonstrates a beneficial long-term effect of localized radiation therapy, consisting of a reduced incidence of vertebral fractures and focal marrow lesions in irradiated vertebrae. (author)

  14. Interdisciplinary Cognitive-Behavioral Therapy as Part of Lumbar Spinal Fusion Surgery Rehabilitation: Experience of Patients With Chronic Low Back Pain.

    Science.gov (United States)

    Lindgreen, Pil; Rolving, Nanna; Nielsen, Claus Vinther; Lomborg, Kirsten

    2016-01-01

    Patients receiving lumbar spinal fusion surgery often have persisting postoperative pain negatively affecting their daily life. These patients may be helped by interdisciplinary cognitive-behavioral therapy which is recognized as an effective intervention for improving beneficial pain coping behavior, thereby facilitating the rehabilitation process of patients with chronic pain. The purpose of this study was to describe the lived experience of patients recovering from lumbar spinal fusion surgery and to explore potential similarities and disparities in pain coping behavior between receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. We conducted semistructured interviews with 10 patients; 5 receiving cognitive-behavioral therapy in connection with their lumbar spinal fusion surgery and 5 receiving usual care. We conducted a phenomenological analysis to reach our first aim and then conducted a comparative content analysis to reach our second aim. Patients' postoperative experience was characterized by the need to adapt to the limitations imposed by back discomfort (coexisting with the back), need for recognition and support from others regarding their pain, a relatively long rehabilitation period during which they "awaited the result of surgery", and ambivalence toward analgesics. The patients in both groups had similar negative perception of analgesics and tended to abstain from them to avoid addiction. Coping behavior apparently differed among receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. Receivers prevented or minimized pain by resting before pain onset, whereas nonreceivers awaited pain onset before resting. The postoperative experience entailed ambivalence, causing uncertainty, worry and insecurity. This ambivalence was relieved when others recognized the patient's pain and offered support. Cognitive-behavioral therapy as part of rehabilitation may have encouraged beneficial pain coping

  15. Spinal electro-magnetic stimulation combined with transgene delivery of neurotrophin NT-3 and exercise: novel combination therapy for spinal contusion injury.

    Science.gov (United States)

    Petrosyan, Hayk A; Alessi, Valentina; Hunanyan, Arsen S; Sisto, Sue A; Arvanian, Victor L

    2015-11-01

    Our recent terminal experiments revealed that administration of a single train of repetitive spinal electromagnetic stimulation (sEMS; 35 min) enhanced synaptic plasticity in spinal circuitry following lateral hemisection spinal cord injury. In the current study, we have examined effects of repetitive sEMS applied as a single train and chronically (5 wk, every other day) following thoracic T10 contusion. Chronic studies involved examination of systematic sEMS administration alone and combined with exercise training and transgene delivery of neurotrophin [adeno-associated virus 10-neurotrophin 3 (AAV10-NT3)]. Electrophysiological intracellular/extracellular recordings, immunohistochemistry, behavioral testing, and anatomical tracing were performed to assess effects of treatments. We found that administration of a single sEMS train induced transient facilitation of transmission through preserved lateral white matter to motoneurons and hindlimb muscles in chronically contused rats with effects lasting for at least 2 h. These physiological changes associated with increased immunoreactivity of GluR1 and GluR2/3 glutamate receptors in lumbar neurons. Systematic administration of sEMS alone for 5 wk, however, was unable to induce cumulative improvements of transmission in spinomuscular circuitry or improve impaired motor function following thoracic contusion. Encouragingly, chronic administration of sEMS, followed by exercise training (running in an exercise ball and swimming), induced the following: 1) sustained strengthening of transmission to lumbar motoneurons and hindlimb muscles, 2) better retrograde transport of anatomical tracer, and 3) improved locomotor function. Greatest improvements were seen in the group that received exercise combined with sEMS and AAV-NT3.

  16. Glioblastoma with spinal seeding

    International Nuclear Information System (INIS)

    Fakhrai, N.; Fazeny-Doerner, B.; Marosi, C.; Czech, T.; Diekmann, K.; Birner, P.; Hainfellner, J.A.; Prayer, D.

    2004-01-01

    Background: extracranial seeding of glioblastoma multiforme (GBM) is very rare and its development depends on several factors. This case report describes two patients suffering from GBM with spinal seeding. In both cases, the anatomic localization of the primary tumor close to the cerebrospinal fluid (CSF) was the main factor for spinal seeding. Case reports: two patients with GBM and spinal seeding are presented. After diagnosis of spinal seeding, both patients were highly symptomatic from their spinal lesions. Case 1 experienced severe pain requiring opiates, and case 2 had paresis of lower limbs as well as urinary retention/incontinence. Both patients were treated with spinal radiation therapy. Nevertheless, they died 3 months after diagnosis of spinal seeding. Results: in both patients the diagnosis of spinal seeding was made at the time of cranial recurrence. Both tumors showed close contact to the CSF initially. Even though the patients underwent intensive treatment, it was not possible to keep them in a symptom-free state. Conclusion: because of short survival periods, patients deserve optimal pain management and dedicated palliative care. (orig.)

  17. Glioblastoma with spinal seeding

    Energy Technology Data Exchange (ETDEWEB)

    Fakhrai, N.; Fazeny-Doerner, B.; Marosi, C. [Clinical Div. of Oncology, Dept. of Medicine I, Univ. of Vienna (Austria); Czech, T. [Dept. of Neurosurgery, Univ. of Vienna (Austria); Diekmann, K. [Dept. of Radiooncology, Univ. of Vienna (Austria); Birner, P.; Hainfellner, J.A. [Clinical Inst. for Neurology, Univ. of Vienna (Austria); Prayer, D. [Dept. of Neuroradiology, Univ. of Vienna (Austria)

    2004-07-01

    Background: extracranial seeding of glioblastoma multiforme (GBM) is very rare and its development depends on several factors. This case report describes two patients suffering from GBM with spinal seeding. In both cases, the anatomic localization of the primary tumor close to the cerebrospinal fluid (CSF) was the main factor for spinal seeding. Case reports: two patients with GBM and spinal seeding are presented. After diagnosis of spinal seeding, both patients were highly symptomatic from their spinal lesions. Case 1 experienced severe pain requiring opiates, and case 2 had paresis of lower limbs as well as urinary retention/incontinence. Both patients were treated with spinal radiation therapy. Nevertheless, they died 3 months after diagnosis of spinal seeding. Results: in both patients the diagnosis of spinal seeding was made at the time of cranial recurrence. Both tumors showed close contact to the CSF initially. Even though the patients underwent intensive treatment, it was not possible to keep them in a symptom-free state. Conclusion: because of short survival periods, patients deserve optimal pain management and dedicated palliative care. (orig.)

  18. Low-energy extracorporeal shock wave therapy promotes vascular endothelial growth factor expression and improves locomotor recovery after spinal cord injury.

    Science.gov (United States)

    Yamaya, Seiji; Ozawa, Hiroshi; Kanno, Haruo; Kishimoto, Koshi N; Sekiguchi, Akira; Tateda, Satoshi; Yahata, Kenichiro; Ito, Kenta; Shimokawa, Hiroaki; Itoi, Eiji

    2014-12-01

    Extracorporeal shock wave therapy (ESWT) is widely used for the clinical treatment of various human diseases. Recent studies have demonstrated that low-energy ESWT upregulates the expression of vascular endothelial growth factor (VEGF) and promotes angiogenesis and functional recovery in myocardial infarction and peripheral artery disease. Many previous reports suggested that VEGF produces a neuroprotective effect to reduce secondary neural tissue damage after spinal cord injury (SCI). The purpose of the present study was to investigate whether low-energy ESWT promotes VEGF expression and neuroprotection and improves locomotor recovery after SCI. Sixty adult female Sprague-Dawley rats were randomly divided into 4 groups: sham group (laminectomy only), sham-SW group (low-energy ESWT applied after laminectomy), SCI group (SCI only), and SCI-SW group (low-energy ESWT applied after SCI). Thoracic spinal cord contusion injury was inflicted using an impactor. Low-energy ESWT was applied to the injured spinal cord 3 times a week for 3 weeks. Locomotor function was evaluated using the Basso, Beattie, and Bresnahan (BBB) Scale (open field locomotor score) at different time points over 42 days after SCI. Hematoxylin and eosin staining was performed to assess neural tissue damage in the spinal cord. Neuronal loss was investigated by immunostaining for NeuN. The mRNA expressions of VEGF and its receptor, Flt-1, in the spinal cord were assessed using real-time polymerase chain reaction. Immunostaining for VEGF was performed to evaluate VEGF protein expression in the spinal cord. In both the sham and sham-SW groups, no animals showed locomotor impairment on BBB scoring. Histological analysis of H & E and NeuN stainings in the sham-SW group confirmed that no neural tissue damage was induced by the low-energy ESWT. Importantly, animals in the SCI-SW group demonstrated significantly better locomotor improvement than those in the SCI group at 7, 35, and 42 days after injury (p

  19. A phase 2 autologous cellular therapy trial in patients with acute, complete spinal cord injury: pragmatics, recruitment, and demographics.

    Science.gov (United States)

    Jones, L A T; Lammertse, D P; Charlifue, S B; Kirshblum, S C; Apple, D F; Ragnarsson, K T; Poonian, D; Betz, R R; Knoller, N; Heary, R F; Choudhri, T F; Jenkins, A L; Falci, S P; Snyder, D A

    2010-11-01

    Post hoc analysis from a randomized controlled cellular therapy trial in acute, complete spinal cord injury (SCI). Description and quantitative review of study logistics, referral patterns, current practice patterns and subject demographics. Subjects were recruited to one of six international study centers. Data are presented from 1816 patients pre-screened, 75 participants screened and 50 randomized. Of the 1816 patients pre-screened, 53.7% did not meet initial study criteria, primarily due to an injury outside the time window (14 days) or failure to meet neurological criteria (complete SCI between C5 motor/C4 sensory and T11). MRIs were obtained on 339 patients; 51.0% were ineligible based on imaging criteria. Of the 75 participants enrolled, 25 failed screening (SF), leaving 50 randomized. The primary reason for SF was based on the neurological exam (51.9%), followed by failure to meet MRI criteria (22.2%). Of the 50 randomized subjects, there were no significant differences in demographics in the active versus control arms. In those participants for whom data was available, 93.8% (45 of 48) of randomized participants received steroids before study entry, whereas 94.0% (47 of 50) had spine surgery before study enrollment. The 'funnel effect' (large numbers of potentially eligible participants with a small number enrolled) impacts all trials, but was particularly challenging in this trial due to eligibility criteria and logistics. Data collected may provide information on current practice patterns and the issues encountered and addressed may facilitate design of future trials.

  20. Quality of Life of Patients with Spinal Metastasis from Cancer of Unknown Primary Origin: A Longitudinal Study of Surgical Management Combined with Postoperative Radiation Therapy.

    Science.gov (United States)

    Ma, Yifei; He, Shaohui; Liu, Tielong; Yang, Xinghai; Zhao, Jian; Yu, Hongyu; Feng, Jiaojiao; Xu, Wei; Xiao, Jianru

    2017-10-04

    Patients with spinal metastasis from cancer of unknown primary origin have limited life expectancy and poor quality of life. Surgery and radiation therapy remain the main treatment options, but, to our knowledge, there are limited data concerning quality-of-life improvement after surgery and radiation therapy and even fewer data on whether surgical intervention would affect quality of life. Patients were enrolled between January 2009 and January 2014 at the Changzheng Hospital, Shanghai, People's Republic of China. The quality of life of 2 patient groups (one group that underwent surgery followed by postoperative radiation therapy and one group that underwent radiation therapy only) was assessed by the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire during a 6-month period. A subgroup analysis of quality of life was performed to compare different surgical strategies in the surgical group. A total of 287 patients, including 191 patients in the group that underwent surgery and 96 patients in the group that underwent radiation therapy only, were enrolled in the prospective study; 177 patients completed all 5 checkpoints and 110 patients had died by the final checkpoint. The surgery group had significantly higher adjusted quality-of-life scores than the radiation therapy group in each domain of the FACT-G questionnaire (all p quality of life in patients with spinal metastasis from cancer of unknown primary origin in the 6-month assessment. In terms of surgical strategies, circumferential decompression seems better than laminectomy alone in quality-of-life improvement. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

  1. Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial

    International Nuclear Information System (INIS)

    Maranzano, Ernesto; Latini, Paolo

    1995-01-01

    Purpose: In assessing effectiveness of radiation therapy (RT) in metastatic spinal cord compression (MSCC), we performed a prospective trial in which patients with this complication were generally treated with RT plus steroids, and surgery was reserved for selected cases. Methods and Materials: Two hundred seventy-five consecutive patients with MSCC entered this protocol. Twenty (7%) underwent surgery plus RT, another 255 received RT alone. Of all eligible patients, 25 (10%) early deaths and 21 (8%) entering a feasibility study of RT without steroids, were not evaluable. Of the 209 evaluable cases, 110 were females and 99 males, and median age was 62 years. Median follow-up was 49 months (range, 13 to 88) and treatment consisted of 30 Gy RT (using two different schedules) together with steroids (standard or high doses, depending on motor deficit severity). Response was assessed according to back pain and motor and bladder function before and after therapy. Results: Back pain total response rate was 82% (complete or partial response or stable pain, 54, 17, or 11%, respectively). About three-fourths of the patients (76%) achieved full recovery or preservation of walking ability and 44% with sphincter dysfunction improved. Early diagnosis was the most important response predictor so that a large majority of patients able to walk and with good bladder function maintained these capacities. When diagnosis was late, tumors with favorable histologies (i.e., myeloma, breast, and prostate carcinomas) above all responded to RT. Duration of response was also influenced by histology. Favorable histologies are associated to higher median response (myeloma, breast, and prostate carcinomas, 16, 12, and 10 months, respectively). Median survival time was 6 months, with a 28% probability of survival for 1 year. Survival time was longer for patients able to walk before and/or after RT, those with favourable histologies, and females. There was agreement between patient survival and

  2. Maladaptive spinal plasticity opposes spinal learning and recovery in spinal cord injury

    Directory of Open Access Journals (Sweden)

    Adam R Ferguson

    2012-10-01

    Full Text Available Synaptic plasticity within the spinal cord has great potential to facilitate recovery of function after spinal cord injury (SCI. Spinal plasticity can be induced in an activity-dependent manner even without input from the brain after complete SCI. The mechanistic basis for these effects is provided by research demonstrating that spinal synapses have many of the same plasticity mechanisms that are known to underlie learning and memory in the brain. In addition, the lumbar spinal cord can sustain several forms of learning and memory, including limb-position training. However, not all spinal plasticity promotes recovery of function. Central sensitization of nociceptive (pain pathways in the spinal cord may emerge with certain patterns of activity, demonstrating that plasticity within the spinal cord may contribute to maladaptive pain states. In this review we discuss interactions between adaptive and maladaptive forms of activity-dependent plasticity in the spinal cord. The literature demonstrates that activity-dependent plasticity within the spinal cord must be carefully tuned to promote adaptive spinal training. Stimulation that is delivered in a limb position-dependent manner or on a fixed interval can induce adaptive plasticity that promotes future spinal cord learning and reduces nociceptive hyper-reactivity. On the other hand, stimulation that is delivered in an unsynchronized fashion, such as randomized electrical stimulation or peripheral skin injuries, can generate maladaptive spinal plasticity that undermines future spinal cord learning, reduces recovery of locomotor function, and promotes nociceptive hyper-reactivity after spinal cord injury. We review these basic phenomena, discuss the cellular and molecular mechanisms, and discuss implications of these findings for improved rehabilitative therapies after spinal cord injury.

  3. Association of lumbar spine stiffness and flexion-relaxation phenomenon with patient-reported outcomes in adults with chronic low back pain - a single-arm clinical trial investigating the effects of thrust spinal manipulation.

    Science.gov (United States)

    Xia, Ting; Long, Cynthia R; Vining, Robert D; Gudavalli, Maruti R; DeVocht, James W; Kawchuk, Gregory N; Wilder, David G; Goertz, Christine M

    2017-06-09

    Spinal manipulation (SM) is used commonly for treating low back pain (LBP). Spinal stiffness is routinely assessed by clinicians performing SM. Flexion-relaxation ratio (FRR) was shown to distinguish between LBP and healthy populations. The primary objective of this study was to examine the association of these two physiological variables with patient-reported pain intensity and disability in adults with chronic LBP (>12 weeks) receiving SM. A single-arm trial provided 12 sessions of side-lying thrust SM in the lumbosacral region over 6 weeks. Inclusion criteria included 21-65 years old, Roland-Morris Disability Questionnaire (RMDQ) score ≥ 6 and numerical pain rating score ≥ 2. Spinal stiffness and FRR were assessed pre-treatment at baseline, after 2 weeks and after 6 weeks of treatment. Lumbar spine global stiffness (GS) were calculated from the force-displacement curves obtained using i) hand palpation, ii) a hand-held device, and iii) an automated indenter device. Lumbar FRR was assessed during trunk flexion-extension using surface electromyography. The primary outcomes were RMDQ and pain intensity measured by visual analog scale (VAS). Mixed-effects regression models were used to analyze the data. The mean age of the 82 participants was 45 years; 48% were female; and 84% reported LBP >1 year. The mean (standard deviation) baseline pain intensity and RMDQ were 46.1 (18.1) and 9.5 (4.3), respectively. The mean reduction (95% confidence interval) after 6 weeks in pain intensity and RMDQ were 20.1 mm (14.1 to 26.1) and 4.8 (3.7 to 5.8). There was a small change over time in the palpatory GS but not in the hand-held or automated GS, nor in FRR. The addition of each physiologic variable did not affect the model-estimated changes in VAS or RMDQ over time. There was no association seen between physiological variables and LBP intensity. Higher levels of hand-held GS at L3 and automated GS were significantly associated with higher levels of RMDQ (p

  4. SU-E-J-85: The Effect of Different Imaging Modalities On the Delineation of the True Spinal Cord for Spinal Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Goddard, L; Brodin, P; Mani, K; Lee, A; Garg, M; Tome, W; Kalnicki, S [Montefiore Medical Center, Bronx, NY (United States)

    2015-06-15

    Purpose: SBRT allows the delivery of high dose radiation treatments to localized tumors while minimizing dose to surrounding tissues. Due to the large doses delivered, accurate contouring of organs at risk is essential. In this study, differences between the true spinal cord as seen using MRI and CT myelogram (CTM) have been assessed in patients with spinal metastases treated using SBRT. Methods: Ten patients were identified that have both a CTM and a MRI. Using rigid registration tools, the MRI was fused to the CTM. The thecal sac and true cord were contoured using each imaging modality. Images were exported and analyzed for similarity by computing the Dice similarity coefficient and the modified Hausdorff distance (greatest distance from a point in one set to the closest point in the other set). Results: The Dice coefficient was calculated for the thecal sac (0.81 ±0.06) and true cord (0.63 ±0.13). These two measures are correlated; however, some points show a low true cord overlap despite a high overlap for the thecal sac. The Hausdorff distance for structure comparisons was also calculated. For thecal sac structures, the average value, 1.6mm (±1.1), indicates good overlap. For true cord comparison, the average value, 0.3mm (±0.16), indicates very good overlap. The minimum Hausdorff distance between the true cord and thecal sac was on average 1.6mm (±0.9) Conclusion: The true cord position as seen in MRI and CTM is fairly constant, although care should be taken as large differences can be seen in individual patients. Avoidning the true cord in spine SBRT is critical, so the ability to visualize the true cord before performing SBRT to the vertebrae is essential. Here, CT myelogram appears an excellent, robust option, that can be obtained the day of treatment planning and is unaffected by uncertainties in image fusion.

  5. The Effect of Negative Pressure Wound Therapy With Antiseptic Instillation on Biofilm Formation in a Porcine Model of Infected Spinal Instrumentation.

    Science.gov (United States)

    Singh, Devinder P; Gowda, Arvind U; Chopra, Karan; Tholen, Michael; Chang, Sarah; Mavrophilipos, Vasilios; Semsarzadeh, Nina; Rasko, Yvonne; Holton Iii, Luther

    2017-06-01

    This study evaluates the effect of negative pressure wound therapy with antiseptic instillation (NPWTi) in the clearance of infection and biofilm formation in an in vivo model of infected spinal implants compared to traditional treatment modalities. Five pigs underwent titanium rod implantation of their spinous processes followed by injection of 1 x 106 CFUs/100μL of methicillin-resistant Staphylococcus aureus through the fascia at each site. At 1 week postoperatively, an experimental arm of 3 pigs received NPWTi, and a control arm of 2 pigs received wet-to-dry dressings. The persistence of local infection in the experimental group was compared to the control group using tissue cultures. Biofilm development on spinal implants was evaluated using scanning electron microscopy. Mean bacterial count showed a statistical difference between the experimental and the control groups (P < .05). Scanning electron microscopy revealed the presence of uniform biofilm formation across the surface of control group instrumentation, whereas the experimental group showed interrupted areas between biofilm formations. The authors concluded that NPWTi is associated with decreased bacterial load and biofilm formation compared to wet-to-dry dressings in an in vivo porcine model of infected spinal instrumentation.

  6. Neuroprotective effect of non-viral gene therapy treatment based on tetanus toxin C-fragment in a severe mouse model of Spinal Muscular Atrophy.

    Directory of Open Access Journals (Sweden)

    Sara Olivan Garcia

    2016-08-01

    Full Text Available Spinal muscular atrophy (SMA is a hereditary childhood disease that causes paralysis and progressive degeneration of skeletal muscles and spinal motor neurons. SMA is associated with reduced levels of full-length Survival of Motor Neuron (SMN protein, due to mutations in the Survival of Motor Neuron 1 gene. Nowadays there are no effective therapies available to treat patients with SMA, so our aim was to test whether the non-toxic carboxy-terminal fragment of tetanus toxin heavy chain (TTC, which exhibits neurotrophic properties, might have a therapeutic role or benefit in SMA. In this manuscript, we have demonstrated that TTC enhance the SMN expression in motor neurons in vitro and evaluated the effect of intramuscular injection of TTC-encoding plasmid in the spinal cord and the skeletal muscle of SMNdelta7 mice. For this purpose, we studied the weight and the survival time, as well as, the survival and cell death pathways and muscular atrophy. Our results showed that TTC treatment reduced the expression of autophagy markers (Becn1, Atg5, Lc3 and p62 and pro-apoptotic genes such as Bax and Casp3 in spinal cord. In skeletal muscle, TTC was able to downregulate the expression of the main marker of autophagy, Lc3, to wild type levels and the expression of the apoptosis effector protein, Casp3. Regarding the genes related to muscular atrophy (Ankrd1, Calm1, Col19a1, Fbox32, Mt2, Myod1, NogoA, Pax7, Rrad, and Sln, TTC suggest a compensatory effect for muscle damage response, diminished oxidative stress and modulated calcium homeostasis. These preliminary findings suggest the need for further experiments to depth study the effect of TTC in SMA disease.

  7. Boron neutron capture therapy: A guide to the understanding of the pathogenesis of late radiation damage to the rat spinal cord

    International Nuclear Information System (INIS)

    Morris, G.M.; Whitehouse, E.M.; Hopewell, J.W.; Coderre, J.A.; Micca, P.

    1994-01-01

    Before the commencement of new boron neutron capture therapy (BNCT) clinical trials in Europe and North America, detailed information on normal tissue tolerance is required. In this study, the pathologic effects of BNCT on the central nervous system (CNS) have been investigated using a rat spinal cord model. The neutron capture agent used was 10 B-enriched sodium mercaptoundecahydro-closo-dodecaborate (BSH), at a dosage of 100 mg/kg body weight. Rats were irradiated on the thermal beam at the Brookhaven Medical Research Reactor. The large spine of vertebra T 2 was used as the lower marker of the irradiation field. Rats were irradiated with thermal neutrons alone to a maximum physical absorbed dose of 11.4 Gy, or with thermal neutrons in combination with BSH, to maximum absorbed physical doses of 5.7 Gy to the CNS parenchyma and 33.7 Gy to the blood in the vasculature of the spinal cord. An additional group of rats was irradiated with 250 kVp X-rays to a single dose of 35 Gy. Spinal cord pathology was examined between 5 and 12 months after irradiation. The physical dose of radiation delivered to the CNS parenchyma, using thermal neutron irradiation in the presence of BSH, was a factor of two to three lower than that delivered to the vascular endothelium, and could not account for the level of damage observed in the parenchyma. The histopathological observations of the present study support the hypothesis that the blood vessels, and the endothelial cells in particular, are the critical target population responsible for the lesions seen in the spinal cord after BNCT type irradiation and by inference, after more conventional irradiation modalities such as photons or fast neutrons. 30 refs., 6 figs., 1 tab

  8. Maladaptive spinal plasticity opposes spinal learning and recovery in spinal cord injury

    Science.gov (United States)

    Ferguson, Adam R.; Huie, J. Russell; Crown, Eric D.; Baumbauer, Kyle M.; Hook, Michelle A.; Garraway, Sandra M.; Lee, Kuan H.; Hoy, Kevin C.; Grau, James W.

    2012-01-01

    Synaptic plasticity within the spinal cord has great potential to facilitate recovery of function after spinal cord injury (SCI). Spinal plasticity can be induced in an activity-dependent manner even without input from the brain after complete SCI. A mechanistic basis for these effects is provided by research demonstrating that spinal synapses have many of the same plasticity mechanisms that are known to underlie learning and memory in the brain. In addition, the lumbar spinal cord can sustain several forms of learning and memory, including limb-position training. However, not all spinal plasticity promotes recovery of function. Central sensitization of nociceptive (pain) pathways in the spinal cord may emerge in response to various noxious inputs, demonstrating that plasticity within the spinal cord may contribute to maladaptive pain states. In this review we discuss interactions between adaptive and maladaptive forms of activity-dependent plasticity in the spinal cord below the level of SCI. The literature demonstrates that activity-dependent plasticity within the spinal cord must be carefully tuned to promote adaptive spinal training. Prior work from our group has shown that stimulation that is delivered in a limb position-dependent manner or on a fixed interval can induce adaptive plasticity that promotes future spinal cord learning and reduces nociceptive hyper-reactivity. On the other hand, stimulation that is delivered in an unsynchronized fashion, such as randomized electrical stimulation or peripheral skin injuries, can generate maladaptive spinal plasticity that undermines future spinal cord learning, reduces recovery of locomotor function, and promotes nociceptive hyper-reactivity after SCI. We review these basic phenomena, how these findings relate to the broader spinal plasticity literature, discuss the cellular and molecular mechanisms, and finally discuss implications of these and other findings for improved rehabilitative therapies after SCI. PMID

  9. Feasibility of sensory tongue stimulation combined with task-specific therapy in people with spinal cord injury: a case study.

    Science.gov (United States)

    Chisholm, Amanda E; Malik, Raza Naseem; Blouin, Jean-Sébastien; Borisoff, Jaimie; Forwell, Susan; Lam, Tania

    2014-06-06

    Previous evidence suggests the effects of task-specific therapy can be further enhanced when sensory stimulation is combined with motor practice. Sensory tongue stimulation is thought to facilitate activation of regions in the brain that are important for balance and gait. Improvements in balance and gait have significant implications for functional mobility for people with incomplete spinal cord injury (iSCI). The aim of this case study was to evaluate the feasibility of a lab- and home-based program combining sensory tongue stimulation with balance and gait training on functional outcomes in people with iSCI. Two male participants (S1 and S2) with chronic motor iSCI completed 12 weeks of balance and gait training (3 lab and 2 home based sessions per week) combined with sensory tongue stimulation using the Portable Neuromodulation Stimulator (PoNS). Laboratory based training involved 20 minutes of standing balance with eyes closed and 30 minutes of body-weight support treadmill walking. Home based sessions consisted of balancing with eyes open and walking with parallel bars or a walker for up to 20 minutes each. Subjects continued daily at-home training for an additional 12 weeks as follow-up. Both subjects were able to complete a minimum of 83% of the training sessions. Standing balance with eyes closed increased from 0.2 to 4.0 minutes and 0.0 to 0.2 minutes for S1 and S2, respectively. Balance confidence also improved at follow-up after the home-based program. Over ground walking speed improved by 0.14 m/s for S1 and 0.07 m/s for S2, and skilled walking function improved by 60% and 21% for S1 and S2, respectively. Sensory tongue stimulation combined with task-specific training may be a feasible method for improving balance and gait in people with iSCI. Our findings warrant further controlled studies to determine the added benefits of sensory tongue stimulation to rehabilitation training.

  10. A manipulator

    International Nuclear Information System (INIS)

    Cole, G.V.; Hofmann, D.A.; Ashby, R.

    1984-01-01

    A manipulator is described, for remote handling of objects within an enclosure, by an operator outside the enclosure. The manipulator consists of a telescopically extensible arm member, the action of which is controlled by a motor-driven lead screw. (U.K.)

  11. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal Cord Injury Rehabilitation Pediatric Spinal ... Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal Cord Injury Rehabilitation Pediatric Spinal ...

  12. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Animated Spinal Cord Injury Chart Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal ... Animated Spinal Cord Injury Chart Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal ...

  13. Integrative therapies for low back pain that include complementary and alternative medicine care: a systematic review.

    Science.gov (United States)

    Kizhakkeveettil, Anupama; Rose, Kevin; Kadar, Gena E

    2014-09-01

    Systematic review of the literature. To evaluate whether an integrated approach that includes different Complementary and Alternative Medicine (CAM) therapies combined or CAM therapies combined with conventional medical care is more effective for the management of low back pain (LBP) than single modalities alone. LBP is one of the leading causes of disability worldwide, yet its optimal management is still unresolved. The PRISMA Statement guidelines were followed. The Cochrane Back Review Group scale was used to rate the quality of the studies found. Twenty-one studies were found that met the inclusion criteria. The CAM modalities used in the studies included spinal manipulative therapy, acupuncture, exercise therapy, physiotherapy, massage therapy, and a topical ointment. Twenty studies included acupuncture and/or spinal manipulative therapy. Nine high quality studies showed that integrative care was clinically effective for the management of LBP. Spinal manipulative therapy combined with exercise therapy and acupuncture combined with conventional medical care or with exercise therapy appears to be promising approaches to the management of chronic cases of LBP. There is support in the literature for integrated CAM and conventional medical therapy for the management of chronic LBP. Further research into the integrated management of LBP is clearly needed to provide better guidance for patients and clinicians.

  14. Effects of Assist-As-Needed Upper Extremity Robotic Therapy after Incomplete Spinal Cord Injury: A Parallel-Group Controlled Trial

    Directory of Open Access Journals (Sweden)

    John Michael Frullo

    2017-06-01

    Full Text Available BackgroundRobotic rehabilitation of the upper limb following neurological injury has been supported through several large clinical studies for individuals with chronic stroke. The application of robotic rehabilitation to the treatment of other neurological injuries is less developed, despite indications that strategies successful for restoration of motor capability following stroke may benefit individuals with incomplete spinal cord injury (SCI as well. Although recent studies suggest that robot-aided rehabilitation might be beneficial after incomplete SCI, it is still unclear what type of robot-aided intervention contributes to motor recovery.MethodsWe developed a novel assist-as-needed (AAN robotic controller to adjust challenge and robotic assistance continuously during rehabilitation therapy delivered via an upper extremity exoskeleton, the MAHI Exo-II, to train independent elbow and wrist joint movements. We further enrolled seventeen patients with incomplete spinal cord injury (AIS C and D levels in a parallel-group balanced controlled trial to test the efficacy of the AAN controller, compared to a subject-triggered (ST controller that does not adjust assistance or challenge levels continuously during therapy. The conducted study is a stage two, development-of-concept pilot study.ResultsWe validated the AAN controller in its capability of modulating assistance and challenge during therapy via analysis of longitudinal robotic metrics. For the selected primary outcome measure, the pre–post difference in ARAT score, no statistically significant change was measured in either group of subjects. Ancillary analysis of secondary outcome measures obtained via robotic testing indicates gradual improvement in movement quality during the therapy program in both groups, with the AAN controller affording greater increases in movement quality over the ST controller.ConclusionThe present study demonstrates feasibility of subject-adaptive robotic therapy

  15. Abdominal Manual Therapy Repairs Interstitial Cells of Cajal and Increases Colonic c-Kit Expression When Treating Bowel Dysfunction after Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Yi Zhu

    2017-01-01

    Full Text Available Background. This study aimed to evaluate the therapeutic effects of abdominal manual therapy (AMT on bowel dysfunction after spinal cord injury (SCI, investigating interstitial cells of Cajal (ICCs and related c-kit expression. Methods. Model rats were divided as SCI and SCI with drug treatment (intragastric mosapride, low-intensity (SCI + LMT; 50 g, 50 times/min, and high-intensity AMT (SCI + HMT; 100 g, 150 times/min. After 14 days of treatment, weight, improved Basso-Beattie-Bresnahan (BBB locomotor score, and intestinal movement were evaluated. Morphological structure of spinal cord and colon tissues were examined. Immunostaining, RT-PCR, and western blot were used to assess c-kit expression. Results. In SCI rats, AMT could not restore BBB, but it significantly increased weight, shortened time to defecation, increased feces amounts, and improved fecal pellet traits and colon histology. AMT improved the number, distribution, and ultrastructure of colonic ICCs, increasing colonic c-kit mRNA and protein levels. Compared with the SCI + Drug and SCI + LMT groups, the SCI + HMT group showed better therapeutic effect in improving intestinal transmission function and promoting c-kit expression. Conclusions. AMT is an effective therapy for recovery of intestinal transmission function. It could repair ICCs and increase c-kit expression in colon tissues after SCI, in a frequency-dependent and pressure-dependent manner.

  16. Imaging in spinal trauma

    International Nuclear Information System (INIS)

    Goethem, J.W.M. van; Maes, Menno; Oezsarlak, Oezkan; Hauwe, Luc van den; Parizel, Paul M.

    2005-01-01

    Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

  17. Imaging in spinal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Goethem, J.W.M. van [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium); Algemeen Ziekenhuis Maria Middelares, Department of Radiology, Sint-Niklaas (Belgium); Maes, Menno; Oezsarlak, Oezkan; Hauwe, Luc van den; Parizel, Paul M. [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium)

    2005-03-01

    Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

  18. Preclinical evidence supporting the clinical development of central pattern generator-modulating therapies for chronic spinal cord-injured patients

    Directory of Open Access Journals (Sweden)

    Pierre eGuertin

    2014-05-01

    Full Text Available Ambulation or walking is one of the main gaits of locomotion. In terrestrial animals, it may be defined as a series of rhythmic and bilaterally coordinated movement of the limbs which creates a forward movement of the body. This applies regardless of the number of limbs - from arthropods with six or more limbs to bipedal primates. These fundamental similarities among species may explain why comparable neural systems and cellular properties have been found, thus far, to control in similar ways locomotor rhythm generation in most animal models. The aim of this article is to provide a comprehensive review of the known structural and functional features associated with central nervous system (CNS networks that are involved in the control of ambulation and other stereotyped motor patterns - specifically Central Pattern Generators (CPGs that produce basic rhythmic patterned outputs for locomotion, micturition, ejaculation, and defecation. Although there is compelling evidence of their existence in humans, CPGs have been most studied in reduced models including in vitro isolated preparations, genetically-engineered mice and spinal cord-transected animals. Compared with other structures of the CNS, the spinal cord is generally considered as being well-preserved phylogenetically. As such, most animal models of SCI should be considered as valuable tools for the development of novel pharmacological strategies aimed at modulating spinal activity and restoring corresponding functions in chronic spinal cord-injured patients.

  19. Radiotherapy of presenile spinal osteoporosis

    International Nuclear Information System (INIS)

    Keim, H.M.; Schiebusch, M.

    1982-01-01

    Painfull conditions of presenile spinal osteoporosis may no longer respond to medication or physical therapy. Analgesic radiotherapy coupled with mild physical therapy and if necessary supported by orthopedic measures frequently results in pain relief and physical stability. Fifty-two cases of osteoporosis and osteoporotic spinal fractures illustrate how better longterm results are achieved by increasing the customary dosage and speeding up radiotherapy. (orig.) [de

  20. Spinal pain

    International Nuclear Information System (INIS)

    Izzo, R.; Popolizio, T.; D’Aprile, P.; Muto, M.

    2015-01-01

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  1. Spinal pain

    Energy Technology Data Exchange (ETDEWEB)

    Izzo, R., E-mail: roberto1766@interfree.it [Neuroradiology Department, A. Cardarelli Hospital, Naples (Italy); Popolizio, T., E-mail: t.popolizio1@gmail.com [Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (Fg) (Italy); D’Aprile, P., E-mail: paoladaprile@yahoo.it [Neuroradiology Department, San Paolo Hospital, Bari (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Department, A. Cardarelli Hospital, Napoli (Italy)

    2015-05-15

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  2. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... spinal cord injuries? play_arrow What is “Braingate” research? play_arrow How would stem-cell therapies work ... cord injuries? play_arrow What does stem-cell research on animals tell us? play_arrow When can ...

  3. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... What is “Braingate” research? play_arrow How would stem-cell therapies work in the treatment of spinal cord injuries? play_arrow What does stem-cell research on animals tell us? play_arrow When ...

  4. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... is “Braingate” research? play_arrow How would stem-cell therapies work in the treatment of spinal cord injuries? play_arrow What does stem-cell research on animals tell us? play_arrow When ...

  5. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Braingate” research? play_arrow How would stem-cell therapies work in the treatment of spinal cord injuries? play_arrow What does stem-cell research on animals tell us? play_arrow When can we expect ...

  6. Low-energy extracorporeal shock wave therapy for promotion of vascular endothelial growth factor expression and angiogenesis and improvement of locomotor and sensory functions after spinal cord injury.

    Science.gov (United States)

    Yahata, Kenichiro; Kanno, Haruo; Ozawa, Hiroshi; Yamaya, Seiji; Tateda, Satoshi; Ito, Kenta; Shimokawa, Hiroaki; Itoi, Eiji

    2016-12-01

    OBJECTIVE Extracorporeal shock wave therapy (ESWT) is widely used to treat various human diseases. Low-energy ESWT increases expression of vascular endothelial growth factor (VEGF) in cultured endothelial cells. The VEGF stimulates not only endothelial cells to promote angiogenesis but also neural cells to induce neuroprotective effects. A previous study by these authors demonstrated that low-energy ESWT promoted expression of VEGF in damaged neural tissue and improved locomotor function after spinal cord injury (SCI). However, the neuroprotective mechanisms in the injured spinal cord produced by low-energy ESWT are still unknown. In the present study, the authors investigated the cell specificity of VEGF expression in injured spinal cords and angiogenesis induced by low-energy ESWT. They also examined the neuroprotective effects of low-energy ESWT on cell death, axonal damage, and white matter sparing as well as the therapeutic effect for improvement of sensory function following SCI. METHODS Adult female Sprague-Dawley rats were divided into the SCI group (SCI only) and SCI-SW group (low-energy ESWT applied after SCI). Thoracic SCI was produced using a New York University Impactor. Low-energy ESWT was applied to the injured spinal cord 3 times a week for 3 weeks after SCI. Locomotor function was evaluated using the Basso, Beattie, and Bresnahan open-field locomotor score for 42 days after SCI. Mechanical and thermal allodynia in the hindpaw were evaluated for 42 days. Double staining for VEGF and various cell-type markers (NeuN, GFAP, and Olig2) was performed at Day 7; TUNEL staining was also performed at Day 7. Immunohistochemical staining for CD31, α-SMA, and 5-HT was performed on spinal cord sections taken 42 days after SCI. Luxol fast blue staining was performed at Day 42. RESULTS Low-energy ESWT significantly improved not only locomotion but also mechanical and thermal allodynia following SCI. In the double staining, expression of VEGF was observed in Neu

  7. Quality of life and fatigue of patients with spinal bone metastases under combined treatment with resistance training and radiation therapy- a randomized pilot trial

    International Nuclear Information System (INIS)

    Rief, Harald; Gioules, Alexandros; Debus, Jürgen; Akbar, Michael; Keller, Monika; Omlor, Georg; Welzel, Thomas; Bruckner, Thomas; Rieken, Stefan; Häfner, Matthias F; Schlampp, Ingmar

    2014-01-01

    The aim of this trial was to compare the effects of resistance training versus passive physical therapy on quality of life (QoL), fatigue, and emotional distress outcomes during radiation therapy in patients with spinal bone metastases under radiotherapy (RT). In this randomized trial, 60 patients were treated from September 2011 until March 2013 into one of the two groups: isometric resistance training or physical therapy with thirty patients in each group during RT. EORTC QLQ-BM22, EORTC QLQ-FA13, and FBK-R10 were assessed at baseline, three months, and six months after RT. Psychosocial aspects in resistance training group (Arm A) were significantly improved after three (p = 0.001) and six months (p = 0.010). Other rated items of the QLQ-BM22 painful site, and pain characteristics were without significant differences. Functional interference showed a positive trend after six months (p = 0.081). After six months, physical fatigue (p = 0.013), and interference with daily life (p = 0.006) according to the QLQ-FA13 assessment improved in Arm A significantly. Emotional distress was in Arm A lower after six months (p = 0.016). The Cohen’s effect size confirmed the clinically significant improvement of these findings. In this group of patients we were able to show that guided isometric resistance training of the paravertebral muscles can improve functional capacity, reduce fatigue and thereby enhance QoL over a 6-months period in patients with stable spinal metastases. The results offer a rationale for future large controlled investigations to confirm these findings

  8. Evaluation of the anatomic effect of physical therapy exercises for mobilization of lumbar spinal nerves and the dura mater in dogs.

    Science.gov (United States)

    Gruenenfelder, Fredrik I; Boos, Alois; Mouwen, Marco; Steffen, Frank

    2006-10-01

    To adapt and standardize neural tissue mobilization exercises, quantify nerve root movement, and assess the anatomic effects of lumbar spinal nerve and dural mobilization in dogs. 15 canine cadavers. 5 cadavers were used in the preliminary part of the study to adapt 3 neural tissue mobilization physical therapy exercises to canine anatomy. In the other 10 cadavers, the L4 to L7 nerve roots and the dura at the level of T13 and L1 were isolated and marked. Movements during the physical therapy exercises were standardized by means of goniometric control. Movement of the nerve roots in response to each exercise was digitally measured. The effects of body weight and crownrump length on the distance of nerve root movement achieved during each exercise were also assessed. Each exercise was divided into 4 steps, and the overall distance of neural movement achieved was compared with distances achieved between steps. Neural tissue mobilization exercises elicited visible and measurable movement of nerve roots L4 to L7 and of the dura at T13 and L1 in all cadavers. The physical therapy exercises evaluated had measurable effects on nerve roots L4 to L7 and the dura mater in the T13 and L1 segments. These exercises should be evaluated in clinical trials to validate their efficacy as primary treatments or ancillary postsurgical therapy in dogs with disorders of the thoracolumbar and lumbosacral segments of the vertebral column.

  9. Spinal Cord Injury 101

    Medline Plus

    Full Text Available menu Understanding Spinal Cord Injury What is a Spinal Cord Injury Levels of Injury and What They Mean Animated Spinal Cord Injury Chart Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal ...

  10. Manipulatives Work!

    Science.gov (United States)

    Moch, Peggy L.

    2001-01-01

    Fifth graders (n=16) engaged in manipulative activities to improve their grasp of math concepts; one-third were identified as exceptional children. Posttest results after 12 lessons showed the overall class average increased from 49% to 59% and all areas improved compared to pretest scores. Attitude changes were also apparent. (Contains 24…

  11. The effect of robo-horseback riding therapy on spinal alignment and associated muscle size in MRI for a child with neuromuscular scoliosis: an experimenter-blind study.

    Science.gov (United States)

    Lee, Dong Ryul; Lee, Nam Gi; Cha, Hyun Jung; Yun Sung, O; You, Sung Joshua Hyun; Oh, Jin Hwan; Bang, Hyo Seong

    2011-01-01

    This case study was conducted to highlight the clinical and radiological features of a patient with progressive neuromuscular scoliosis before and after robo-horseback riding therapy (HBRT). A clinical, laboratory, and radiological analysis of a single case. An 11-year-old child, dignosed right thoracolumbar neuromuscular scoliosis secondary to cerebral palsy. The child received a 5-week course of robo-HBRT, comprising of 60-minute periods a day, five times a week. Postural alignment was determined by Cobb's method. A real-time magnetic resonance imaging (MRI) was performed to determine the robo-HBRT-induced changes in cross-sectional area (CSA) of bilateral thoracic (T2) and lumbar (L2) paraspinalis. Clinical tests including the standard Gross Motor Function Measure (GMFM) and manual muscle testing (MMT) with the Lafayette Manual Muscle Tester were used to compare the intervention-related changes in motor performance and power. The surface EMG was also used to examine therapy-induced changes in muscle activity amplitude for bilateral T2 and L2 paraspinalis and rectus abdominis muscles. Clinical motor and strength scores increased after the intervention. Radiographic Cobb's angle, MRI, and electromyographic amplitude data demonstrated notably enhanced spinal alignment and muscle fiber CSA and symmetry, respectively. This is the first study to provide evidence of the therapeutic efficacy of a novel form of robo-HBRT on motor function and associated structural and motor control improvements, thus suggesting a method of augmenting therapy in neuromuscular scoliosis.

  12. Comparing conVEntional RadioTherapy with stereotactIC body radiotherapy in patients with spinAL metastases: study protocol for an randomized controlled trial following the cohort multiple randomized controlled trial design

    International Nuclear Information System (INIS)

    Velden, Joanne M. van der; Verkooijen, Helena M.; Seravalli, Enrica; Hes, Jochem; Gerlich, A. Sophie; Kasperts, Nicolien; Eppinga, Wietse S. C.; Verlaan, Jorrit-Jan; Vulpen, Marco van

    2016-01-01

    Standard radiotherapy is the treatment of first choice in patients with symptomatic spinal metastases, but is only moderately effective. Stereotactic body radiation therapy is increasingly used to treat spinal metastases, without randomized evidence of superiority over standard radiotherapy. The VERTICAL study aims to quantify the effect of stereotactic radiation therapy in patients with metastatic spinal disease. This study follows the ‘cohort multiple Randomized Controlled Trial’ design. The VERTICAL study is conducted within the PRESENT cohort. In PRESENT, all patients with bone metastases referred for radiation therapy are enrolled. For each patient, clinical and patient-reported outcomes are captured at baseline and at regular intervals during follow-up. In addition, patients give informed consent to be offered experimental interventions. Within PRESENT, 110 patients are identified as a sub cohort of eligible patients (i.e. patients with unirradiated painful, mechanically stable spinal metastases who are able to undergo stereotactic radiation therapy). After a protocol amendment, also patients with non-spinal bony metastases are eligible. From the sub cohort, a random selection of patients is offered stereotactic radiation therapy (n = 55), which patients may accept or refuse. Only patients accepting stereotactic radiation therapy sign informed consent for the VERTICAL trial. Non-selected patients (n = 55) receive standard radiotherapy, and are not aware of them serving as controls. Primary endpoint is pain response after three months. Data will be analyzed by intention to treat, complemented by instrumental variable analysis in case of substantial refusal of the stereotactic radiation therapy in the intervention arm. This study is designed to quantify the treatment response after (stereotactic) radiation therapy in patients with symptomatic spinal metastases. This is the first randomized study in palliative care following the cohort multiple Randomized

  13. Spinal stenosis

    Science.gov (United States)

    ... in the spine that was present from birth Narrow spinal canal that the person was born with Herniated or slipped disk, which ... when you sit down or lean forward. Most people with spinal stenosis cannot walk for a long ... During a physical exam, your health care provider will try to ...

  14. Spinal canal stenosis; Spinalkanalstenose

    Energy Technology Data Exchange (ETDEWEB)

    Papanagiotou, P.; Boutchakova, M. [Klinikum Bremen-Mitte/Bremen-Ost, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Bremen (Germany)

    2014-11-15

    Spinal stenosis is a narrowing of the spinal canal by a combination of bone and soft tissues, which can lead to mechanical compression of spinal nerve roots or the dural sac. The lumbal spinal compression of these nerve roots can be symptomatic, resulting in weakness, reflex alterations, gait disturbances, bowel or bladder dysfunction, motor and sensory changes, radicular pain or atypical leg pain and neurogenic claudication. The anatomical presence of spinal canal stenosis is confirmed radiologically with computerized tomography, myelography or magnetic resonance imaging and play a decisive role in optimal patient-oriented therapy decision-making. (orig.) [German] Die Spinalkanalstenose ist eine umschriebene, knoechern-ligamentaer bedingte Einengung des Spinalkanals, die zur Kompression der Nervenwurzeln oder des Duralsacks fuehren kann. Die lumbale Spinalkanalstenose manifestiert sich klinisch als Komplex aus Rueckenschmerzen sowie sensiblen und motorischen neurologischen Ausfaellen, die in der Regel belastungsabhaengig sind (Claudicatio spinalis). Die bildgebende Diagnostik mittels Magnetresonanztomographie, Computertomographie und Myelographie spielt eine entscheidende Rolle bei der optimalen patientenbezogenen Therapieentscheidung. (orig.)

  15. Quality of life, fatigue and local response of patients with unstable spinal bone metastases under radiation therapy - a prospective trial

    International Nuclear Information System (INIS)

    Rief, Harald; Heinhold, Maximiliane; Bruckner, Thomas; Schlampp, Ingmar; Förster, Robert; Welzel, Thomas; Bostel, Tilman; Debus, Jürgen; Rieken, Stefan

    2014-01-01

    To evaluate the local response according to stability after radiotherapy (RT) with a special focus on quality-of-life (QoL), fatigue, pain and emotional distress in patients with unstable spinal bone metastases. In this prospective trial, 30 patients were treated from September 2011 until March 2013. The stability of osteolytic metastases in the thoracic and lumbar spine was evaluated on the basis of the Taneichi-score after three and six months. EORTC QLQ-BM22, EORTC QLQ-FA13, and QSC-R10 were assessed at baseline, and three months after RT. After 3 months, 25% (n = 6) and after 6 months 33.3% (n = 8) were classified as stable. QoL, fatigue, and emotional distress showed no difference over the course. The pain response 3 months after RT showed a significant difference (p < 0.001). Pathological fractures occurred in 8.3% of the patients (n = 2) within six months following RT. Our trial demonstrated that RT can improve stability in one third of patients over a 6-months period with unstable spinal metastases. Importantly, for these patients pain relief was detected but RT had no impact on QoL, fatigue, and emotional distress

  16. Subdural Thoracolumbar Spine Hematoma after Spinal Anesthesia: A Rare Occurrence and Literature Review of Spinal Hematomas after Spinal Anesthesia.

    Science.gov (United States)

    Maddali, Prasanthi; Walker, Blake; Fisahn, Christian; Page, Jeni; Diaz, Vicki; Zwillman, Michael E; Oskouian, Rod J; Tubbs, R Shane; Moisi, Marc

    2017-02-16

    Spinal hematomas are a rare but serious complication of spinal epidural anesthesia and are typically seen in the epidural space; however, they have been documented in the subdural space. Spinal subdural hematomas likely exist within a traumatically induced space within the dural border cell layer, rather than an anatomical subdural space. Spinal subdural hematomas present a dangerous clinical situation as they have the potential to cause significant compression of neural elements and can be easily mistaken for spinal epidural hematomas. Ultrasound can be an effective modality to diagnose subdural hematoma when no epidural blood is visualized. We have reviewed the literature and present a full literature review and a case presentation of an 82-year-old male who developed a thoracolumbar spinal subdural hematoma after spinal epidural anesthesia. Anticoagulant therapy is an important predisposing risk factor for spinal epidural hematomas and likely also predispose to spinal subdural hematomas. It is important to consider spinal subdural hematomas in addition to spinal epidural hematomas in patients who develop weakness after spinal epidural anesthesia, especially in patients who have received anticoagulation.

  17. Utility of routine evaluation of sterility of cellular therapy products with or without extensive manipulation: Best practices and clinical significance.

    Science.gov (United States)

    Golay, Josee; Pedrini, Olga; Capelli, Chiara; Gotti, Elisa; Borleri, Gianmaria; Magri, Mara; Vailati, Francesca; Passera, Marco; Farina, Claudio; Rambaldi, Alessandro; Introna, Martino

    2018-02-01

    We analyzed the results of routine sterility testing performed in our center over the last 10 years, in the context both hematopoietic stem cell transplantation (HSCT) and Advanced Therapeutic Medicinal Products (ATMPs). For sterility tests 14-day cultures were performed in culture media detecting aerobic and anaerobic microorganisms. In this study, 22/1643 (1.3%) of apheretic products for autologous or allogeneic HSCT were contaminated, whereas 14/73 bone marrow (BM) harvests (17.8%) were positive. In 22 cases, the contaminated HSCs were infused to patients, but there was no evidence of any adverse impact of contamination on the hematologic engraftment or on infections. Indeed none of the five positive hemocultures detected in patients following infusion could be linked to the contaminated stem cell product. Our Cell Factory also generated 286 ATMPs in good manufacturing practice (GMP) conditions since 2007 and all final products were sterile. In three cases of mesenchymal stromal cell expansions, the starting BM harvests were contaminated, but the cell products at the end of expansion were sterile, presumably thanks to the presence of an antibiotic in the culture medium. The decreased rate of contamination of cell harvests observed with time suggests that routine sterility testing and communication of the results to the collecting centers may improve clinical practices. Furthermore, we recommend the use of antibiotics in the medium for ATMP expansion, to decrease the likelihood of expanding microorganisms within clean rooms. Finally we discuss the costs of sterility testing of ATMPs by GMP-approved external laboratories. Copyright © 2017 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

  18. Currency Manipulation

    OpenAIRE

    Weithing Zhang; Thomas Mertens; Tarek Hassan

    2014-01-01

    Many central banks manage the stochastic behavior of their currencies' exchange rates by imposing pegs relative to a target currency. We study the effects of such currency manipulation in a multi-country model of exchange rate determination with endogenous capital accumulation. We find that the imposition of an exchange rate peg relative to a given target currency increases the volatility of consumption in the target country and decreases the volatility of the target currency's exchange rate ...

  19. Short term treatment versus long term management of neck and back disability in older adults utilizing spinal manipulative therapy and supervised exercise

    DEFF Research Database (Denmark)

    Vihstadt, Corrie; Maiers, Michele; Westrom, Kristine

    2014-01-01

    ENDPOINT: 36 weeks post-randomization. DATA COLLECTION: Self-report questionnaires administered at 2 baseline visits and 4, 12, 24, 36, 52, and 78 weeks post-randomization. Primary outcomes include back and neck disability, measured by the Oswestry Disability Index and Neck Disability Index. Secondary...... outcomes include pain, general health status, improvement, self-efficacy, kinesiophobia, satisfaction, and medication use. Functional outcome assessment occurs at baseline and week 37 for hand grip strength, short physical performance battery, and accelerometry. Individual qualitative interviews...

  20. Hydraulic manipulator

    International Nuclear Information System (INIS)

    Sinha, A.K.; Srikrishnamurty, G.

    1990-01-01

    Successful operation of nuclear plant is largely dependent on safe handling of radio-active material. In order to reduce this handling problem and minimise the exposure of radiation, various handling equipment and manipulators have been developed according to the requirements. Manufacture of nuclear fuel, which is the most important part of the nuclear industry, involves handling of uranium ingots weighing approximately 250 kg. This paper describes a specially designed hydraulic manipulator for handling of the ingots in a limited space. It was designed to grab and handle the ingots in any position. This has following drive motions: (1)gripping and releasing, (2)lifting and lowering (z-motion), (3)rotation about the horizontal axis (azimuth drive), (4)rotation about the job axis, and (5)rotation about the vertical axis. For horizontal motion (X and Y axis motion) this equipment is mounted on a motorised trolley, so that it can move inside the workshop. For all drives except the rotation about the job axis, hydraulic cylinders have been used with a battery operated power pack. Trolley drive is also given power from same battery. This paper describes the design aspects of this manipulator. (author). 4 figs

  1. A Grading System To Evaluate Objectively the Strength of Pre-Clinical Data of Acute Neuroprotective Therapies for Clinical Translation in Spinal Cord Injury

    Science.gov (United States)

    Okon, Elena B.; Tsai, Eve; Beattie, Michael S.; Bresnahan, Jacqueline C.; Magnuson, David K.; Reier, Paul J.; McTigue, Dana M.; Popovich, Phillip G.; Blight, Andrew R.; Oudega, Martin; Guest, James D.; Weaver, Lynne C.; Fehlings, Michael G.; Tetzlaff, Wolfram

    2011-01-01

    Abstract The past three decades have seen an explosion of research interest in spinal cord injury (SCI) and the development of hundreds of potential therapies that have demonstrated some promise in pre-clinical experimental animal models. A growing number of these treatments are seeking to be translated into human clinical trials. Conducting such a clinical trial, however, is extremely costly, not only for the time and money required to execute it, but also for the limited resources that will then no longer be available to evaluate other promising therapies. The decision about what therapies have sufficient pre-clinical evidence of efficacy to justify testing in humans is therefore of utmost importance. Here, we have developed a scoring system for objectively grading the body of pre-clinical literature on neuroprotective treatments for acute SCI. The components of the system include an evaluation of a number of factors that are thought to be important in considering the “robustness” of a therapy's efficacy, including the animal species and injury models that have been used to test it, the time window of efficacy, the types of functional improvements effected by it, and whether efficacy has been independently replicated. The selection of these factors was based on the results of a questionnaire that was performed within the SCI research community. A modified Delphi consensus-building exercise was then conducted with experts in pre-clinical SCI research to refine the criteria and decide upon how to score them. Finally, the grading system was applied to a series of potential neuroprotective treatments for acute SCI. This represents a systematic approach to developing an objective method of evaluating the extent to which the pre-clinical literature supports the translation of a particular experimental treatment into human trials. PMID:20507235

  2. Spinal cord involvement in tuberculous meningitis.

    Science.gov (United States)

    Garg, R K; Malhotra, H S; Gupta, R

    2015-09-01

    To summarize the incidence and spectrum of spinal cord-related complications in patients of tuberculous meningitis. Reports from multiple countries were included. An extensive review of the literature, published in English, was carried out using Scopus, PubMed and Google Scholar databases. Tuberculous meningitis frequently affects the spinal cord and nerve roots. Initial evidence of spinal cord involvement came from post-mortem examination. Subsequent advancement in neuroimaging like conventional lumbar myelography, computed tomographic myelography and gadolinium-enhanced magnetic resonance-myelography have contributed immensely. Spinal involvement manifests in several forms, like tuberculous radiculomyelitis, spinal tuberculoma, myelitis, syringomyelia, vertebral tuberculosis and very rarely spinal tuberculous abscess. Frequently, tuberculous spinal arachnoiditis develops paradoxically. Infrequently, spinal cord involvement may even be asymptomatic. Spinal cord and spinal nerve involvement is demonstrated by diffuse enhancement of cord parenchyma, nerve roots and meninges on contrast-enhanced magnetic resonance imaging. High cerebrospinal fluid protein content is often a risk factor for arachnoiditis. The most important differential diagnosis of tuberculous arachnoiditis is meningeal carcinomatosis. Anti-tuberculosis therapy is the main stay of treatment for tuberculous meningitis. Higher doses of corticosteroids have been found effective. Surgery should be considered only when pathological confirmation is needed or there is significant spinal cord compression. The outcome in these patients has been unpredictable. Some reports observed excellent recovery and some reported unfavorable outcomes after surgical decompression and debridement. Tuberculous meningitis is frequently associated with disabling spinal cord and radicular complications. Available treatment options are far from satisfactory.

  3. Variations of high frequency parameter of heart rate variability following osteopathic manipulative treatment in healthy subjects compared to control group and sham therapy: randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Nuria eRuffini

    2015-08-01

    Full Text Available Context: Heart Rate Variability (HRV indicates how heart rate changes in response to inner and external stimuli. HRV is linked to health status and it is an indirect marker of the autonomic nervous system (ANS function. Objective: To investigate the influence of osteopathic manipulative treatment (OMT on ANS activity through changes of High Frequency, a heart rate variability index indicating the parasympathetic activity, in healthy subjects, compared with sham therapy and control group.Methods: Sixty-six healthy subjects, both male and female, were included in the present 3-armed randomized placebo controlled within subject cross-over single blinded study. Participants were asymptomatic adults, both smokers and non-smokers and not on medications. At enrollment subjects were randomized in 3 groups: A, B, C. Standardized structural evaluation followed by a patient need-based osteopathic treatment was performed in the first session of group A and in the second session of group B. Standardized evaluation followed by a protocoled sham treatment was provided in the second session of group A and in the first session of group B. No intervention was performed in the two sessions of group C, acting as a time-control. The trial was registered on clinicaltrials.gov identifier: NCT01908920.Main Outcomes Measures: HRV was calculated from electrocardiography before, during and after the intervention, for a total amount time of 25 minutes.Results: OMT engendered a statistically significant increase of parasympathetic activity, as shown by High Frequency rate (p<0.001, and decrease of sympathetic activity, as revealed by Low Frequency rate (p<0.01; results also showed a reduction of Low Frequency/High Frequency ratio (p<0.001 and Detrended fluctuation scaling exponent (p<0.05. Conclusions: Findings suggested that OMT can influence ANS activity increasing parasympathetic function and decreasing sympathetic activity, compared to sham therapy and control group.

  4. Spinal injury

    Science.gov (United States)

    ... Dallas, TX: American Red Cross; 2016. Kaji AH, Newton EJ, Hockberger RS. Spinal injuries. In: Marx JA, ... member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www. ...

  5. Spinal infections

    International Nuclear Information System (INIS)

    Tali, E. Turgut; Gueltekin, Serap

    2005-01-01

    Spinal infections have an increasing prevalence among the general population. Definitive diagnosis based solely on clinical grounds is usually not possible and radiological imaging is used in almost all patients. The primary aim of the authors is to present an overview of spinal infections located in epidural, intradural and intramedullary compartments and to provide diagnostic clues regarding different imaging modalities, particularly MRI, to the practicing physicians and radiologists. (orig.)

  6. Spinal cysticercosis

    International Nuclear Information System (INIS)

    Goedert, A.V.; Silva, S.H.F.

    1990-01-01

    Spinal cysticercosis is an extremely uncommon condition. We have examined four patients with complaints that resembled nervous root compression by disk herniation. Myelography was shown to be an efficient method to evaluate spinal involvement, that was characterized by findings of multiple filling defect images (cysts) plus signs of adhesive arachnoiditis. One cyst was found to be mobile. Because of the recent development of medical treatment, a quick and precise diagnosis is of high importance to determine the prognosis of this condition. (author)

  7. Effect on healthcare utilization and costs of spinal manual therapy for acute low back pain in routine care: A propensity score matched cohort study.

    Science.gov (United States)

    Walker, Jochen; Mertens, Ulf Kai; Schmidt, Carsten Oliver; Chenot, Jean-François

    2017-01-01

    Spinal manual therapy (SMT) is a popular treatment option for low back pain (LBP). The aim of our analysis was to evaluate the effects of manual therapy delivered by general practitioners and ambulatory orthopedic surgeons in routine care on follow up consultations, sick leave, health service utilization and costs for acute LBP compared to matched patients not receiving manual therapy. This is a propensity score matched cohort study based on health claims data. We identified a total of 113.652 adult patients with acute LBP and no coded red flags of whom 21.021 (18%) received SMT by physicians. In the final analysis 17.965 patients in each group could be matched. Balance on patients' coded characteristics, comorbidity and prior health service utilization was achieved. The provision of SMT for acute LBP had no relevant impact on follow up visits and days of sick leave for LBP in the index billing period and the following year. SMT was associated with a higher proportion of imaging studies for LBP (30.6% vs. 23%, SMD: 0.164 [95% CI 0.143-0.185]). SMT did not lead to meaningful savings by replacing other health services for LBP. SMT for acute non-specific LBP in routine care was not clinically meaningful effective to reduce sick leave and reconsultation rates compared to no SMT and did not lead to meaningful savings by replacing other health services from the perspective of health insurance. This does not imply that SMT is ineffective but might reflect a problem with selection of suitable patients and the quality and quantity of SMT in routine care. National Manual Medicine societies should state clearly that imaging is not routinely needed prior to SMT in patients with low suspicion of presence of red flags and monitor the quality of provided services.

  8. Effect on healthcare utilization and costs of spinal manual therapy for acute low back pain in routine care: A propensity score matched cohort study.

    Directory of Open Access Journals (Sweden)

    Jochen Walker

    Full Text Available Spinal manual therapy (SMT is a popular treatment option for low back pain (LBP. The aim of our analysis was to evaluate the effects of manual therapy delivered by general practitioners and ambulatory orthopedic surgeons in routine care on follow up consultations, sick leave, health service utilization and costs for acute LBP compared to matched patients not receiving manual therapy. This is a propensity score matched cohort study based on health claims data. We identified a total of 113.652 adult patients with acute LBP and no coded red flags of whom 21.021 (18% received SMT by physicians. In the final analysis 17.965 patients in each group could be matched. Balance on patients' coded characteristics, comorbidity and prior health service utilization was achieved. The provision of SMT for acute LBP had no relevant impact on follow up visits and days of sick leave for LBP in the index billing period and the following year. SMT was associated with a higher proportion of imaging studies for LBP (30.6% vs. 23%, SMD: 0.164 [95% CI 0.143-0.185]. SMT did not lead to meaningful savings by replacing other health services for LBP. SMT for acute non-specific LBP in routine care was not clinically meaningful effective to reduce sick leave and reconsultation rates compared to no SMT and did not lead to meaningful savings by replacing other health services from the perspective of health insurance. This does not imply that SMT is ineffective but might reflect a problem with selection of suitable patients and the quality and quantity of SMT in routine care. National Manual Medicine societies should state clearly that imaging is not routinely needed prior to SMT in patients with low suspicion of presence of red flags and monitor the quality of provided services.

  9. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Cord Injury What is a Spinal Cord Injury Levels of Injury and What They Mean Animated Spinal ... Cord Injury What is a Spinal Cord Injury Levels of Injury and What They Mean Animated Spinal ...

  10. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Injury Chart Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal Cord Injury Rehabilitation ... Injury Chart Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal Cord Injury Rehabilitation ...

  11. Restoring voluntary grasping function in individuals with incomplete chronic spinal cord injury: pilot study.

    Science.gov (United States)

    Kapadia, Naaz; Zivanovic, Vera; Popovic, Milos R

    2013-01-01

    Functional electrical stimulation (FES) therapy has been shown to be one of the most promising approaches for improving voluntary grasping function in individuals with subacute cervical spinal cord injury (SCI). To determine the effectiveness of FES therapy, as compared to conventional occupational therapy (COT), in improving voluntary hand function in individuals with chronic (≥24 months post injury), incomplete (American Spinal Injury Association Impairment Scale [AIS] B-D), C4 to C7 SCI. Eight participants were randomized to the intervention group (FES therapy; n = 5) or the control group (COT; n = 3). Both groups received 39 hours of therapy over 13 to 16 weeks. The primary outcome measure was the Toronto Rehabilitation Institute-Hand Function Test (TRI-HFT), and the secondary outcome measures were Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), Functional Independence Measure (FIM) self-care subscore, and Spinal Cord Independence Measure (SCIM) self-care subscore. Outcome assessments were performed at baseline, after 39 sessions of therapy, and at 6 months following the baseline assessment. After 39 sessions of therapy, the intervention group improved by 5.8 points on the TRI-HFT's Object Manipulation Task, whereas the control group changed by only 1.17 points. Similarly, after 39 sessions of therapy, the intervention group improved by 4.6 points on the FIM self-care subscore, whereas the control group did not change at all. The results of the pilot data justify a clinical trial to compare FES therapy and COT alone to improve voluntary hand function in individuals with chronic incomplete tetraplegia.

  12. Manipulative therapies for infantile colic

    NARCIS (Netherlands)

    Dobson, D.; Lucassen, P.L.; Miller, J.J.; Vlieger, A.M.; Prescott, P.; Lewith, G.

    2012-01-01

    BACKGROUND: Infantile colic is a common disorder, affecting around one in six families, and in 2001 was reported to cost the UK National Health Service in excess of pound65 million per year (Morris 2001). Although it usually remits by six months of age, there is some evidence of longer-term sequelae

  13. Effects of employing a 10B-carrier and manipulating intratumour hypoxia on local tumour response and lung metastatic potential in boron neutron capture therapy

    Science.gov (United States)

    Masunaga, S; Sakurai, Y; Tanaka, H; Suzuki, M; Liu, Y; Kondo, N; Maruhashi, A; Kinashi, Y; Ono, K

    2012-01-01

    Objectives To evaluate the effects of employing a 10B-carrier and manipulating intratumour hypoxia on local tumour response and lung metastatic potential in boron neutron capture therapy (BNCT) by measuring the response of intratumour quiescent (Q) cells. Methods B16-BL6 melanoma tumour-bearing C57BL/6 mice were continuously given 5-bromo-2′-deoxyuridine (BrdU) to label all proliferating (P) cells. The tumours received reactor thermal neutron beam irradiation following the administration of a 10B-carrier [L-para-boronophenylalanine-10B (BPA) or sodium mercaptoundecahydrododecaborate-10B (BSH)] in combination with an acute hypoxia-releasing agent (nicotinamide) or mild temperature hyperthermia (MTH). Immediately after the irradiation, cells from some tumours were isolated and incubated with a cytokinesis blocker. The responses of the Q and total (P+Q) cell populations were assessed based on the frequency of micronuclei using immunofluorescence staining for BrdU. In other tumour-bearing mice, macroscopic lung metastases were enumerated 17 days after irradiation. Results BPA-BNCT increased the sensitivity of the total tumour cell population more than BSH-BNCT. However, the sensitivity of Q cells treated with BPA was lower than that of BSH-treated Q cells. With or without a 10B–carrier, MTH enhanced the sensitivity of the Q cell population. Without irradiation, nicotinamide treatment decreased the number of lung metastases. With irradiation, BPA-BNCT, especially in combination with nicotinamide treatment, showed the potential to reduce the number of metastases more than BSH-BNCT. Conclusion BSH-BNCT in combination with MTH improves local tumour control, while BPA-BNCT in combination with nicotinamide may reduce the number of lung metastases. PMID:22391496

  14. Targeted therapies using electrical and magnetic neural stimulation for the treatment of chronic pain in spinal cord injury.

    Science.gov (United States)

    Moreno-Duarte, Ingrid; Morse, Leslie R; Alam, Mahtab; Bikson, Marom; Zafonte, Ross; Fregni, Felipe

    2014-01-15

    Chronic neuropathic pain is one of the most common and disabling symptoms in individuals with spinal cord injury (SCI). Over two-thirds of subjects with SCI suffer from chronic pain influencing quality of life, rehabilitation, and recovery. Given the refractoriness of chronic pain to most pharmacological treatments, the majority of individuals with SCI report worsening of this condition over time. Moreover, only 4-6% of patients in this cohort report improvement. Novel treatments targeting mechanisms associated with pain-maladaptive plasticity, such as electromagnetic neural stimulation, may be desirable to improve outcomes. To date, few, small clinical trials have assessed the effects of invasive and noninvasive nervous system stimulation on pain after SCI. We aimed to review initial efficacy, safety and potential predictors of response by assessing the effects of neural stimulation techniques to treat SCI pain. A literature search was performed using the PubMed database including studies using the following targeted stimulation strategies: transcranial Direct Current Stimulation (tDCS), High Definition tDCS (HD-tDCS), repetitive Transcranial Magnetical Stimulation (rTMS), Cranial Electrotherapy Stimulation (CES), Transcutaneous Electrical Nerve Stimulation (TENS), Spinal Cord Stimulation (SCS) and Motor Cortex Stimulation (MCS), published prior to June of 2012. We included studies from 1998 to 2012. Eight clinical trials and one naturalistic observational study (nine studies in total) met the inclusion criteria. Among the clinical trials, three studies assessed the effects of tDCS, two of CES, two of rTMS and one of TENS. The naturalistic study investigated the analgesic effects of SCS. No clinical trials for epidural motor cortex stimulation (MCS) or HD-tDCS were found. Parameters of stimulation and also clinical characteristics varied significantly across studies. Three out of eight studies showed larger effects sizes (0.73, 0.88 and 1.86 respectively) for pain

  15. Evaluation of the cost-effectiveness of electrical stimulation therapy for pressure ulcers in spinal cord injury.

    Science.gov (United States)

    Mittmann, Nicole; Chan, Brian C; Craven, B Cathy; Isogai, Pierre K; Houghton, Pamela

    2011-06-01

    To evaluate the incremental cost-effectiveness of electrical stimulation (ES) plus standard wound care (SWC) as compared with SWC only in a spinal cord injury (SCI) population with grade III/IV pressure ulcers (PUs) from the public payer perspective. A decision analytic model was constructed for a 1-year time horizon to determine the incremental cost-effectiveness of ES plus SWC to SWC in a cohort of participants with SCI and grade III/IV PUs. Model inputs for clinical probabilities were based on published literature. Model inputs, namely clinical probabilities and direct health system and medical resources were based on a randomized controlled trial of ES plus SWC versus SWC. Costs (Can $) included outpatient (clinic, home care, health professional) and inpatient management (surgery, complications). One way and probabilistic sensitivity (1000 Monte Carlo iterations) analyses were conducted. The perspective of this analysis is from a Canadian public health system payer. Model target population was an SCI cohort with grade III/IV PUs. Not applicable. Incremental cost per PU healed. ES plus SWC were associated with better outcomes and lower costs. There was a 16.4% increase in the PUs healed and a cost savings of $224 at 1 year. ES plus SWC were thus considered a dominant economic comparator. Probabilistic sensitivity analysis resulted in economic dominance for ES plus SWC in 62%, with another 35% having incremental cost-effectiveness ratios of $50,000 or less per PU healed. The largest driver of the economic model was the percentage of PU healed with ES plus SWC. The addition of ES to SWC improved healing in grade III/IV PU and reduced costs in an SCI population. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. Spinal tumors

    International Nuclear Information System (INIS)

    Goethem, J.W.M. van; Hauwe, L. van den; Oezsarlak, Oe.; Schepper, A.M.A. de; Parizel, P.M.

    2004-01-01

    Spinal tumors are uncommon lesions but may cause significant morbidity in terms of limb dysfunction. In establishing the differential diagnosis for a spinal lesion, location is the most important feature, but the clinical presentation and the patient's age and gender are also important. Magnetic resonance (MR) imaging plays a central role in the imaging of spinal tumors, easily allowing tumors to be classified as extradural, intradural-extramedullary or intramedullary, which is very useful in tumor characterization. In the evaluation of lesions of the osseous spine both computed tomography (CT) and MR are important. We describe the most common spinal tumors in detail. In general, extradural lesions are the most common with metastasis being the most frequent. Intradural tumors are rare, and the majority is extramedullary, with meningiomas and nerve sheath tumors being the most frequent. Intramedullary tumors are uncommon spinal tumors. Astrocytomas and ependymomas comprise the majority of the intramedullary tumors. The most important tumors are documented with appropriate high quality CT or MR images and the characteristics of these tumors are also summarized in a comprehensive table. Finally we illustrate the use of the new World Health Organization (WHO) classification of neoplasms affecting the central nervous system

  17. Spinal multiparametric MRI and DEXA changes over time in men with prostate cancer treated with androgen deprivation therapy: a potential imaging biomarker of treatment toxicity

    International Nuclear Information System (INIS)

    Martin, Jarad; Arm, Jameen; Smart, Joanne; Palazzi, Kerrin; Capp, Anne; Ainsworth, Paul; Cowin, Gary

    2017-01-01

    To explore changes in bone mineral density (BMD) measured by DEXA and MRS fat fraction (FF), Dixon FF, and ADC in lower spinal vertebral bodies in men with prostate cancer treated with androgen deprivation therapy (ADT). Twenty-eight men were enrolled onto a clinical trial. All received ADT. DEXA imaging was performed at baseline and 12 months. L-spine MRI was done at baseline and 6 months. The number of patients who underwent DEXA, Dixon, ADC, and MRS at baseline/follow-up were 28/27, 28/26, 28/26, and 22/20. An increase in FF was observed from T11 to S2 (average 1 %/vertebra). There was a positive correlation between baseline MRS FF and Dixon FF (r = 0.85, p < 0.0001) and a negative correlation between MRS FF and ADC (r = -0.56, p = 0.036). Over 6 months, MRS FF increased by a median of 25 % in relative values (p = 0.0003), Dixon FF increased (p < 0.0001) and ADC values decreased (p = 0.0014). Men with >5 % BMD loss after 1 year had triple the percentage increase in MRS FF at 6 months (61.1 % vs. 20.9 %, p = 0.19). Changes are observed on L-spine MRI after 6 months of ADT. Further investigation is warranted of MRS change as a potential predictive biomarker for later BMD loss. (orig.)

  18. Long-Term Safety Issues of iPSC-Based Cell Therapy in a Spinal Cord Injury Model: Oncogenic Transformation with Epithelial-Mesenchymal Transition

    Directory of Open Access Journals (Sweden)

    Satoshi Nori

    2015-03-01

    Full Text Available Previously, we described the safety and therapeutic potential of neurospheres (NSs derived from a human induced pluripotent stem cell (iPSC clone, 201B7, in a spinal cord injury (SCI mouse model. However, several safety issues concerning iPSC-based cell therapy remain unresolved. Here, we investigated another iPSC clone, 253G1, that we established by transducing OCT4, SOX2, and KLF4 into adult human dermal fibroblasts collected from the same donor who provided the 201B7 clone. The grafted 253G1-NSs survived, differentiated into three neural lineages, and promoted functional recovery accompanied by stimulated synapse formation 47 days after transplantation. However, long-term observation (for up to 103 days revealed deteriorated motor function accompanied by tumor formation. The tumors consisted of Nestin+ undifferentiated neural cells and exhibited activation of the OCT4 transgene. Transcriptome analysis revealed that a heightened mesenchymal transition may have contributed to the progression of tumors derived from grafted cells.

  19. Using a Modified ADAPTE Process to Enable Effective Implementation of Electrical Stimulation Therapy for Treating Pressure Ulcers in Persons With Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Deena Lala

    2017-12-01

    Full Text Available Objectives: To apply a modified ADAPTE process to adapt best practices to a local context for successful implementation of electrical stimulation therapy (EST for treating pressure injuries in persons with spinal cord injury (SCI. Participants: An expert team of health care professionals and a consumer participated in a 2-day workshop to assist in the development of the locally adapted EST document in Southwest Ontario, Canada. Results: A process map illustrating the flow of activities to initiate EST for treating pressure injuries in persons with SCI based on the challenges and opportunities existing within this region was created. The team also developed a summary of roles and responsibilities delineating tasks specific to providing EST and identified a set of challenges likely to be encountered. Conclusions: The modified ADAPTE process provided a clear and flexible structure to adaptation when used for implementation planning. This article shares some challenges associated with using this process for local adaptation and shares strategies of improvement for future studies aimed at adapting a practice to their local environment.

  20. Spinal multiparametric MRI and DEXA changes over time in men with prostate cancer treated with androgen deprivation therapy: a potential imaging biomarker of treatment toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Martin, Jarad [Calvary Mater Newcastle, Department of Radiation Oncology, Newcastle, New South Wales (Australia); University of Newcastle, School of Medicine and Public Health, Newcastle, New South Wales (Australia); University of Queensland, Centre for Advanced Imaging, Brisbane, Queensland (Australia); Arm, Jameen [Hunter New England Imaging, Newcastle, New South Wales (Australia); Smart, Joanne [Calvary Mater Newcastle, Department of Radiation Oncology, Newcastle, New South Wales (Australia); Palazzi, Kerrin [CREDITSS, Hunter Medical Research Institute, Newcastle, New South Wales (Australia); Capp, Anne [Calvary Mater Newcastle, Department of Radiation Oncology, Newcastle, New South Wales (Australia); University of Newcastle, School of Medicine and Public Health, Newcastle, New South Wales (Australia); Ainsworth, Paul [Hunter New England Health, Department of Urology, Newcastle, New South Wales (Australia); Cowin, Gary [University of Queensland, Centre for Advanced Imaging, Brisbane, Queensland (Australia)

    2017-03-15

    To explore changes in bone mineral density (BMD) measured by DEXA and MRS fat fraction (FF), Dixon FF, and ADC in lower spinal vertebral bodies in men with prostate cancer treated with androgen deprivation therapy (ADT). Twenty-eight men were enrolled onto a clinical trial. All received ADT. DEXA imaging was performed at baseline and 12 months. L-spine MRI was done at baseline and 6 months. The number of patients who underwent DEXA, Dixon, ADC, and MRS at baseline/follow-up were 28/27, 28/26, 28/26, and 22/20. An increase in FF was observed from T11 to S2 (average 1 %/vertebra). There was a positive correlation between baseline MRS FF and Dixon FF (r = 0.85, p < 0.0001) and a negative correlation between MRS FF and ADC (r = -0.56, p = 0.036). Over 6 months, MRS FF increased by a median of 25 % in relative values (p = 0.0003), Dixon FF increased (p < 0.0001) and ADC values decreased (p = 0.0014). Men with >5 % BMD loss after 1 year had triple the percentage increase in MRS FF at 6 months (61.1 % vs. 20.9 %, p = 0.19). Changes are observed on L-spine MRI after 6 months of ADT. Further investigation is warranted of MRS change as a potential predictive biomarker for later BMD loss. (orig.)

  1. Air acupuncture therapy combined with manipulation on 90 cases of acute sprain and bruising of ankle joint%气针加手法治疗急性踝关节扭挫伤90例

    Institute of Scientific and Technical Information of China (English)

    王永红; 李斌

    2003-01-01

    @@ BACKGROUND: Air acupuncture therapy is to make use of time and space stimuli of air in acupoint and promote blood circulation to remove blood stasis, relieve swelling and pain through interstitial osmosis and absorption. Manipulation to acute sprain and bruising of ankle joint can achieve anatomic reduction as soon as possible, clear incarceration of synovium, promote circulation of qi and relieve pain and increase blood circulation of affected tissue.

  2. Tri-wave laser therapy for spinal cord injury, neuropathic pain management, and restoration of motor function

    Science.gov (United States)

    Chariff, Mark D.; Olszak, Peter

    2015-03-01

    A laser therapy device using three combined wavelengths 532nm, 808nm, and 1064nm has been demonstrated in clinical studies. Primarily, therapeutic lasers have used wavelengths in the ranges of 632nm through 1064nm, where the optical density (OD) pain relief and tissue regeneration. Conventional wisdom would argue against using wavelengths in the region of 532nm, due to poor penetration (OD ~ 8); however, the author's observations are to the contrary. The 532nm light is efficiently absorbed by chromophores such as oxyhemoglobin, deoxyhemoglobin, and cytochrome c oxidase thereby providing energy to accelerate the healing process. The 808nm light is known to result in Nitric Oxide production thereby reducing inflammation and oxidative stress. All three laser wavelengths likely contribute to pain relief by inhibiting nerve conduction; however, the 1064nm has the deepest penetration. Through the use of this device on over 1000 patients with a variety of acute and chronic neuro-musculoskeletal disorders, the author observed that a majority of these individuals experienced rapid relief from their presenting conditions and most patients reported a tingling sensation upon irradiation. Patient testimonials and thermal images have been collected to document the results of the laser therapy. These studies demonstrate the ability of laser therapy to rapidly alleviate pain from both acute and chronic conditions.

  3. Large-scale chondroitin sulfate proteoglycan digestion with chondroitinase gene therapy leads to reduced pathology and modulates macrophage phenotype following spinal cord contusion injury

    NARCIS (Netherlands)

    Bartus, Katalin; James, Nicholas D; Didangelos, Athanasios; Bosch, Karen D; Verhaagen, J.; Yáñez-Muñoz, Rafael J; Rogers, John H; Schneider, Bernard L; Muir, Elizabeth M; Bradbury, Elizabeth J

    2014-01-01

    Chondroitin sulfate proteoglycans (CSPGs) inhibit repair following spinal cord injury. Here we use mammalian-compatible engineered chondroitinase ABC (ChABC) delivered via lentiviral vector (LV-ChABC) to explore the consequences of large-scale CSPG digestion for spinal cord repair. We demonstrate

  4. Spinal tuberculosis.

    Science.gov (United States)

    Dunn, R N; Ben Husien, M

    2018-04-01

    Tuberculosis (TB) remains endemic in many parts of the developing world and is increasingly seen in the developed world due to migration. A total of 1.3 million people die annually from the disease. Spinal TB is the most common musculoskeletal manifestation, affecting about 1 to 2% of all cases of TB. The coexistence of HIV, which is endemic in some regions, adds to the burden and the complexity of management. This review discusses the epidemiology, clinical presentation, diagnosis, impact of HIV and both the medical and surgical options in the management of spinal TB. Cite this article: Bone Joint J 2018;100-B:425-31.

  5. Stereotactic Body Radiation Therapy for Spinal Metastases in the Postoperative Setting: A Secondary Analysis of Mature Phase 1-2 Trials

    Energy Technology Data Exchange (ETDEWEB)

    Tao, Randa; Bishop, Andrew J.; Brownlee, Zachary; Allen, Pamela K.; Settle, Stephen H. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chang, Eric L. [Department of Radiation Oncology, USC Norris Cancer Hospital, Keck School of Medicine of USC, Los Angeles, California (United States); Wang, Xin [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Amini, Behrang [Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tannir, Nizar M. [Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tatsui, Claudio; Rhines, Laurence D. [Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Brown, Paul D. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Ghia, Amol J., E-mail: ajghia@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2016-08-01

    Purpose: To evaluate the outcomes in patients treated on prospective phase 1-2 protocols with postoperative stereotactic body radiation therapy (SBRT) and identify the associated prognostic variables. Methods and Materials: Sixty-six patients with 69 tumors were treated with SBRT on prospective phase 1-2 studies for spinal metastases between 2002 and 2010. All patients underwent SBRT after spine surgery, which included laminectomy, vertebrectomy, or a combination of these techniques. Renal cell carcinoma was the most common histology represented (n=35, 53%) followed by sarcomas (n=13, 20%). Thirty-one patients (47%) were treated with prior conventional radiation to the spine (median dose 30 Gy). Patients were followed up with spinal magnetic resonance imaging (MRI) studies to determine the treated tumor control (TC). Pain and other symptom data were collected prospectively to determine treatment response and toxicity. Results: The median follow-up time was 30 months (range, 1-145 months) for all patients and 75 months for living patients (range, 6-145 months). The actuarial 1-year rate of TC was 85%, adjacent vertebral body control was 85%, and overall survival (OS) was 74% (median 29 months). On multivariate competing-risks analysis, sarcoma histology (subhazard ratio [SHR] = 2.38, 95% confidence interval [CI] 1.05-5.6, P=.04) and larger preoperative tumor volumes (SHR=1.01, 95% CI 1.0-1.01, P=.006) were significantly associated with worse TC. Karnofsky performance status was the only significant predictor for OS on multivariate analysis. There were no differences in TC between patients treated with different surgical techniques or different preoperative or postoperative Bilsky grades. There were no grade 3 or higher neurologic toxicities. Conclusion: This study represents a large series of prospective data available on patients treated with SBRT in the postoperative setting. The combination of surgery with SBRT can offer patients with metastatic disease

  6. The Use of Virtual Reality to Facilitate Mindfulness Skills Training in Dialectical Behavioral Therapy for Spinal Cord Injury: A Case Study.

    Science.gov (United States)

    Flores, Araceli; Linehan, Marsha M; Todd, S Rob; Hoffman, Hunter G

    2018-01-01

    Introduction: Paralysis from a spinal cord injury (SCI) increases risk of psychological problems including suicide attempts, substance use disorder, negative emotions (e.g., anger), depression, anxiety, ASD/PTSD. Dialectical Behavioral Therapy® (DBT®) has been shown to be effective for treating similar psychological symptoms in non-SCI patient populations. The current study explored for the first time, the feasibility and clinical potential of using Immersive Virtual Reality (VR) enhanced DBT® Mindfulness skills training to help reduce psychological symptoms (negative emotions and anxiety, ASD/PTSD) of two patients with SCI. Patient 1 was a 39-year-old male patient suffering multiple spinal cord injuries, resulting in quadriplegia, after falling out of a four story building. Patient 1 had severe depression, and anxiety symptoms. Patient 2, was a 31 year old male with a C7 vertebral body fracture, leading to paresis, after suffering a blunt force trauma injury during an attempted suicide, jumping from a moving vehicle. Patient 2 had mild depression, and anxiety symptoms. Methods: Each patient looked into VR goggles, and had the illusion of slowly "floating down" a river in virtual reality while listening to DBT® Mindfulness Skills training instructions. Each patient filled out brief psychological ratings before and after each VR session, four VR DBT® sessions for patient 1, and two VR DBT® sessions for patient 2. Results: As predicted, patient 1 reported reductions in negative emotions after each VR DBT® Mindfulness session. Patient 2 had mixed results on some of the measures of negative emotions. And both patients reported feeling less depressed, less anxious, and less emotionally upset, after VR DBT® Mindfulness Skills learning. Patient 2 reported large reductions in short term ASD/PTSD symptoms after his first VR DBT® mindfulness skills training session. Conclusion: This study explored the feasibility of using VR DBT® with quadriplegic or paresis SCI

  7. The Use of Virtual Reality to Facilitate Mindfulness Skills Training in Dialectical Behavioral Therapy for Spinal Cord Injury: A Case Study

    Directory of Open Access Journals (Sweden)

    Araceli Flores

    2018-04-01

    Full Text Available Introduction: Paralysis from a spinal cord injury (SCI increases risk of psychological problems including suicide attempts, substance use disorder, negative emotions (e.g., anger, depression, anxiety, ASD/PTSD. Dialectical Behavioral Therapy® (DBT® has been shown to be effective for treating similar psychological symptoms in non-SCI patient populations. The current study explored for the first time, the feasibility and clinical potential of using Immersive Virtual Reality (VR enhanced DBT® Mindfulness skills training to help reduce psychological symptoms (negative emotions and anxiety, ASD/PTSD of two patients with SCI. Patient 1 was a 39-year-old male patient suffering multiple spinal cord injuries, resulting in quadriplegia, after falling out of a four story building. Patient 1 had severe depression, and anxiety symptoms. Patient 2, was a 31 year old male with a C7 vertebral body fracture, leading to paresis, after suffering a blunt force trauma injury during an attempted suicide, jumping from a moving vehicle. Patient 2 had mild depression, and anxiety symptoms.Methods: Each patient looked into VR goggles, and had the illusion of slowly “floating down” a river in virtual reality while listening to DBT® Mindfulness Skills training instructions. Each patient filled out brief psychological ratings before and after each VR session, four VR DBT® sessions for patient 1, and two VR DBT® sessions for patient 2.Results: As predicted, patient 1 reported reductions in negative emotions after each VR DBT® Mindfulness session. Patient 2 had mixed results on some of the measures of negative emotions. And both patients reported feeling less depressed, less anxious, and less emotionally upset, after VR DBT® Mindfulness Skills learning. Patient 2 reported large reductions in short term ASD/PTSD symptoms after his first VR DBT® mindfulness skills training session.Conclusion: This study explored the feasibility of using VR DBT® with quadriplegic

  8. Stereotactic Body Radiation Therapy for Spinal Metastases in the Postoperative Setting: A Secondary Analysis of Mature Phase 1-2 Trials

    International Nuclear Information System (INIS)

    Tao, Randa; Bishop, Andrew J.; Brownlee, Zachary; Allen, Pamela K.; Settle, Stephen H.; Chang, Eric L.; Wang, Xin; Amini, Behrang; Tannir, Nizar M.; Tatsui, Claudio; Rhines, Laurence D.; Brown, Paul D.; Ghia, Amol J.

    2016-01-01

    Purpose: To evaluate the outcomes in patients treated on prospective phase 1-2 protocols with postoperative stereotactic body radiation therapy (SBRT) and identify the associated prognostic variables. Methods and Materials: Sixty-six patients with 69 tumors were treated with SBRT on prospective phase 1-2 studies for spinal metastases between 2002 and 2010. All patients underwent SBRT after spine surgery, which included laminectomy, vertebrectomy, or a combination of these techniques. Renal cell carcinoma was the most common histology represented (n=35, 53%) followed by sarcomas (n=13, 20%). Thirty-one patients (47%) were treated with prior conventional radiation to the spine (median dose 30 Gy). Patients were followed up with spinal magnetic resonance imaging (MRI) studies to determine the treated tumor control (TC). Pain and other symptom data were collected prospectively to determine treatment response and toxicity. Results: The median follow-up time was 30 months (range, 1-145 months) for all patients and 75 months for living patients (range, 6-145 months). The actuarial 1-year rate of TC was 85%, adjacent vertebral body control was 85%, and overall survival (OS) was 74% (median 29 months). On multivariate competing-risks analysis, sarcoma histology (subhazard ratio [SHR] = 2.38, 95% confidence interval [CI] 1.05-5.6, P=.04) and larger preoperative tumor volumes (SHR=1.01, 95% CI 1.0-1.01, P=.006) were significantly associated with worse TC. Karnofsky performance status was the only significant predictor for OS on multivariate analysis. There were no differences in TC between patients treated with different surgical techniques or different preoperative or postoperative Bilsky grades. There were no grade 3 or higher neurologic toxicities. Conclusion: This study represents a large series of prospective data available on patients treated with SBRT in the postoperative setting. The combination of surgery with SBRT can offer patients with metastatic disease

  9. Manipulation Therapy Relieved Pain More Rapidly Than Acupuncture among Lateral Epicondylalgia (Tennis Elbow Patients: A Randomized Controlled Trial with 8-Week Follow-Up

    Directory of Open Access Journals (Sweden)

    Chung-Yuan Hsu

    2016-01-01

    Full Text Available Radial bone adjustment manipulation treatment may be effective to reduce pain rapidly in lateral epicondylalgia patients and the pathological tension in the biceps brachii muscle is highly concerned. To prove this hypothesis, we conducted a randomized controlled trial and included 35 patients with lateral epicondylalgia for more than 2 months. Either manipulation treatment (n=16 or acupuncture (n=19 was given to these patients for 2 weeks and all patients’ symptoms were followed up for 8 weeks after treatment. Both groups demonstrated changes in pain VAS score, grip strength, and DASH questionnaire. Lateral epicondylalgia patients who received manipulation treatment felt pain relief sooner than those who had acupuncture treatments during the first few treatments. However, both acupuncture and manipulation are effective, while the difference has no significance at the 8-week follow-up. The trial was registered with Current Controlled Trials ISRCTN81308551 on 5 February 2016.

  10. Negative Pressure Wound Therapy in Infected Wound following Posterior Spinal Instrumentation using Simple Self-assembled System: A Case Report

    Directory of Open Access Journals (Sweden)

    CW Chang

    2014-07-01

    Full Text Available Postoperative wound infection in an instrumented spine patient is often disastrous. Management includes implant removal leading to spine instability. Negative pressure wound therapy (NPWT applied to the spine surgical wound is one of the wound care technique with successful results. We report a case of a man who sustained Chance fracture of Lumbar 1 (L1 vertebra treated with long segment posterior instrumentation, who unfortunately developed Extended-spectrum beta-lactamase (ESBL positive E. coli infection one month after the operation. After careful debridement of the wound, the implant became exposed. Three cycles of NPWT were applied and the wound healed with granulation tissue completely covering the implant, and thus negating the need to remove the implant. In conclusion, the NPWT is a good alternative in postoperative wound management especially in an instrumented spine patient.

  11. Resilience following spinal cord injury: A prospective controlled study investigating the influence of the provision of group cognitive behavior therapy during inpatient rehabilitation.

    Science.gov (United States)

    Guest, Rebecca; Craig, Ashley; Nicholson Perry, Kathryn; Tran, Yvonne; Ephraums, Catherine; Hales, Alison; Dezarnaulds, Annalisa; Crino, Rocco; Middleton, James

    2015-11-01

    To examine change in resilience in people with spinal cord injury (SCI) when group cognitive behavior therapy (GCBT) was added to routine psychosocial rehabilitation (RPR). A prospective repeated-measures cohort design was used to determine the efficacy of the addition of GCBT (n = 50). The control group consisted of individuals receiving RPR, which included access to individual CBT (ICBT) when required (n = 38). Groups were assessed on 3 occasions: soon after admission, within 2 weeks of discharge, and 6-months postdischarge. Measures included sociodemographic, injury, and psychosocial factors. The outcome variable was resilience, considered an important outcome measure for recovery. To adjust for baseline differences in self-efficacy, depressive mood and anxiety between the 2 groups, these factors were entered into a repeated measures multivariate analysis of covariance (MANCOVA) as covariates. Latent class analysis was used to determine the best-fitting model of resilience trajectories for both groups. The MANCOVA indicated that the addition of GCBT to psychosocial rehabilitation did not result in improved resilience compared with the ICBT group. Trajectory data indicated over 60% were demonstrating acceptable resilience irrespective of group. Changes in resilience mean scores suggest the addition of GCBT adds little to resilience outcomes. Latent class modeling indicated both groups experienced similar trajectories of improvement and deterioration. Results highlight the importance of conducting multivariate modeling analysis that isolates subgroups of related cases over time to understand complex trajectories. Further research is needed to clarify individual differences in CBT intervention preference as well as other factors which impact on resilience. (c) 2015 APA, all rights reserved).

  12. Possible adverse events in children treated by manual therapy: a review

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    Humphreys B Kim

    2010-06-01

    Full Text Available Abstract Background Pediatric manual therapy is controversial within the medical community particularly with respect to adverse events. Pediatric manual therapy (Ped MT is commonly used by a number of professions such as chiropractors, osteopaths and naturopaths for a variety of treatments in children. Ped MT interventions range from advice, light touch, massage, through to mobilisation and high velocity spinal manipulation. However, current evidence related to adverse events associated with Ped MT is not well understood. Objective To update the clinical research literature from the 2007 report by Vohra, Johnston, Cramer and Humphreys on possible adverse events in children treated by spinal manipulation. Methods A review of the clinical research literature from June 2004 until January 2010 as reported in MEDLINE, PubMed and PubMed Central for adverse events specifically related to the treatment of pediatric cases by manual therapy. Results Only three new clinical studies, one systematic review with meta-analysis and one evidence report were identified. Two clinical studies reported on chiropractic care and one on osteopathic spinal manipulation in children. The systematic review investigated all studies of adverse events and manual therapy and was not specific for pediatric patients. The evidence review focused on effectiveness of spinal manipulation in a variety of musculoskeletal conditions. No serious or catastrophic adverse events were reported in the clinical studies or systematic review. However for adults, it has been estimated that between 0.003% and 0.13% of manual therapy treatments may result in a serious adverse event. Although mild to moderate adverse events are common in adults, an accurate estimate from high quality pediatric studies is currently not available. Conclusions There is currently insufficient research evidence related to adverse events and manual therapy. However, clinical studies and systematic reviews from adult

  13. Therapy of an incomplete spinal cord injury by intrathecal injection of EPO and subcutaneous injection of EPO, vitamin C and G-CSF.

    Science.gov (United States)

    Bader, Augustinus; Reinhardt, Martin; Beuthe, Achim; Röhl, Klaus; Giri, Shibashish

    2017-01-01

    Spinal cord injury is a rare disease with an incidence about 40 cases per million population in the USA. The most common reasons are traffic accidents, falls, violence and sports. A 53-year-old male patient presented with an incomplete tetraparesis as a result of a spinal cord injury after the accident. It was not possible to treat him with steroids because he was out of the therapeutic time period of 8 hours when he presented to the hospital. The main problem of spinal cord injuries is the secondary injury caused by inflammation and swelling of the spinal cord. To avoid this, the patient was experimentally treated with erythropoietin (EPO) intrathecal and EPO, granulocyte-colony-stimulating factor and vitamin C subcutaneous after his initial spinal cord relief surgery. These drugs might be able to relieve this secondary reaction but were never applied for this indication in human before. This study shows that it could be a promising treatment for spinal cord injuries with potential therapeutic benefits.

  14. Life satisfaction in patients with and without spinal cord ischemia after advanced endovascular therapy for extensive aortic disease at mid-term follow-up.

    Science.gov (United States)

    Mehmedagic, Irma; Santén, Stefan; Jörgensen, Sophie; Acosta, Stefan

    2016-11-11

    Advanced endovascular aortic repair can be used to treat patients with extensive and complex aortic disease who are at risk of spinal cord ischaemia. The aim of this study was to compare whether life satisfaction differs between patients with and without spinal cord ischaemia at mid-term follow-up. Nested case-control study. Among patients undergoing advanced endovascular aortic repair between 2009 and 2012, 18 patients with spinal cord ischaemia and 33 without were interviewed at home. The Life Satisfaction Questionnaire (LiSat-11) and the Satisfaction With Life Scale (SWLS) were used. LiSat-11 found that patients with spinal cord ischaemia were more dissatisfied with their activities of daily living than were patients without spinal cord ischaemia (p=0.012). Both groups had similar, very low, scores in the sexual life domain; median 2.0 (interquartile range (IQR) 1.5-3.0) and 3.0 (IQR 2.0-4.0), respectively. There was no difference in SWLS between the groups. This study cohort of patients who underwent advanced endovascular aortic repair was rather homo-genous in their rating of life satisfaction and there was little difference between mid-term survivors who had spinal cord ischaemia and those who did not.

  15. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... spinal cord injury? play_arrow What kind of surgery is common after a spinal cord injury? play_ ... How soon after a spinal cord injury should surgery be performed? play_arrow Is it common to ...

  16. Spinal Cord Injury 101

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    Full Text Available ... L Sarah Harrison, OT Anne Bryden, OT The Role of the Social Worker after Spinal Cord Injury ... a spinal cord injury important? play_arrow What role does “compression” play in a spinal cord injury? ...

  17. Spinal Cord Injury 101

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    Full Text Available ... Cord Injury Diane M. Rowles, MS, NP How Family Life Changes After Spinal Cord Injury Nancy Rosenberg, ... Children with Spinal Cord Injury Patricia Mucia, RN Family Life After Pediatric Spinal Injury Dawn Sheaffer, MSW ...

  18. Spinal Cord Injury 101

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    Full Text Available ... Counseling Blog About Media Donate Spinal Cord Injury Medical Expert Videos Topics menu Topics Spinal Cord Injury ... Jennifer Piatt, PhD David Chen, MD Read Bio Medical Director, Spinal Cord Injury Rehabilitation Program, Rehabilitation Institute ...

  19. Spinal Cord Injury 101

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    Full Text Available ... Blog About Media Donate Spinal Cord Injury Medical Expert Videos Topics menu Topics Spinal Cord Injury 101 ... arrow What is the “Spinal Cord Injury Model Systems” program? play_arrow What are the most promising ...

  20. Spinal Cord Injury 101

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    Full Text Available ... Topic Resources Peer Counseling Blog About Media Donate Spinal Cord Injury Medical Expert Videos Topics menu Topics Spinal Cord Injury 101 Adult Injuries Spinal Cord Injury 101 David ...

  1. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Topic Resources Peer Counseling Blog About Media Donate Spinal Cord Injury Medical Expert Videos Topics menu Topics Spinal Cord Injury 101 Adult Injuries Spinal Cord Injury 101 ...

  2. Spinal Cord Diseases

    Science.gov (United States)

    Your spinal cord is a bundle of nerves that runs down the middle of your back. It carries signals back ... of the spine, this can also injure the spinal cord. Other spinal cord problems include Tumors Infections such ...

  3. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Spinal Cord Injury 101 Lawrence Vogel, MD The Basics of Pediatric SCI Rehabilitation Sara Klaas, MSW Transitions for Children with Spinal Cord Injury Patricia Mucia, RN Family Life After Pediatric Spinal Injury Dawn Sheaffer, MSW Rehabilitation ...

  4. Cost-effectiveness of manual therapy for the management of musculoskeletal conditions: a systematic review and narrative synthesis of evidence from randomized controlled trials.

    Science.gov (United States)

    Tsertsvadze, Alexander; Clar, Christine; Court, Rachel; Clarke, Aileen; Mistry, Hema; Sutcliffe, Paul

    2014-01-01

    The purpose of this study was to systematically review trial-based economic evaluations of manual therapy relative to other alternative interventions used for the management of musculoskeletal conditions. A comprehensive literature search was undertaken in major medical, health-related, science and health economic electronic databases. Twenty-five publications were included (11 trial-based economic evaluations). The studies compared cost-effectiveness and/or cost-utility of manual therapy interventions to other treatment alternatives in reducing pain (spinal, shoulder, ankle). Manual therapy techniques (e.g., osteopathic spinal manipulation, physiotherapy manipulation and mobilization techniques, and chiropractic manipulation with or without other treatments) were more cost-effective than usual general practitioner (GP) care alone or with exercise, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. Chiropractic manipulation was found to be less costly and more effective than alternative treatment compared with either physiotherapy or GP care in improving neck pain. Preliminary evidence from this review shows some economic advantage of manual therapy relative to other interventions used for the management of musculoskeletal conditions, indicating that some manual therapy techniques may be more cost-effective than usual GP care, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. However, at present, there is a paucity of evidence on the cost-effectiveness and/or cost-utility evaluations for manual therapy interventions. Further improvements in the methodological conduct and reporting quality of economic evaluations of manual therapy are warranted in order to facilitate adequate evidence-based decisions among policy makers, health care practitioners, and patients. Copyright © 2014 National University

  5. Spinal cord contusion.

    Science.gov (United States)

    Ju, Gong; Wang, Jian; Wang, Yazhou; Zhao, Xianghui

    2014-04-15

    Spinal cord injury is a major cause of disability with devastating neurological outcomes and limited therapeutic opportunities, even though there are thousands of publications on spinal cord injury annually. There are two major types of spinal cord injury, transaction of the spinal cord and spinal cord contusion. Both can theoretically be treated, but there is no well documented treatment in human being. As for spinal cord contusion, we have developed an operation with fabulous result.

  6. Tratamiento mediante terapia de presión negativa VAC® de herida infectada tras artrodesis raquídea Treatment of infected wound secondary to spinal arthrodesis with negative pressure therapy VAC®

    Directory of Open Access Journals (Sweden)

    V. Yuste Benavente

    2011-12-01

    Full Text Available Las complicaciones cutáneas secundarias a artrodesis raquídea son un problema frecuente que requiere la colaboración de los Servicios de Cirugía Plástica y en cuyo tratamiento la terapia de presión negativa puede resultar útil. En este artículo presentamos el caso de un paciente afectado por metástasis vertebrales de adenocarcinoma gástrico que requirió artrodesis raquídea y desarrolló posteriormente una úlcera por presión dorsal debido al material implantado. El sistema VAC® permitió la limpieza y disminución de tamaño de la lesión, siendo posible la cobertura posterior de la misma con un colgajo miocutáneo de dorsal ancho. En este artículo discutimos la utilidad de la terapia de presión negativa en este tipo de lesiones.Cutaneous complications secondary to spinal fusion are a common problem that requires the collaboration of the Department of Plastic Surgery and in which negative pressure therapy treatment may be useful. In this paper we present the case of a patient with spinal metastases secondary to gastric adenocarcinoma that required spinal fusion and developed a dorsal pressure ulcer secondary to the implanted material. VAC® therapy system allowed cleaning the wound and decreasing the size of the injury, thus making it possible subsequently to cover it with a latissimus dorsi myocutaneous flap. In this paper we discuss the usefulness of negative pressure therapy in this type of injury.

  7. Arteriovenous malformations of the cervical spinal cord

    International Nuclear Information System (INIS)

    Nagasawa, Shiro; Yoshida, Shinzo; Ishikawa, Masatsune; Yonekawa, Yasuhiro; Handa, Hajime

    1984-01-01

    Arteriovenous malformation (AVM) of the cervical spinal cord has been known to constitute 5-13% of all spinal AVMs. In contrast to the AVMs located in thoracic or thoraco-lumbar regions, cervical AVM has several characteristic features such as preponderance in younger generation, high incidence of subarachnoid hemorrhage, intramedullary location of the nidus usually fed by the anterior spinal arterial system. We reported three cases of cervical AVMs, which located intramedullary at the levels of C 4 -C 6 , C 1 -C 4 and C 1 -C 2 , respectively. Although selective angiography (vertebral artery, thyrocervical artery, costocervical artery) was essential for the diagnosis of these lesions, computerized tomographic (CT) study with both intrathecal injection of metrizamide and intravenous infusion of contrast material (dynamic and static study) was found to be extremely advantageous in detecting the topography of AVMs in the concerned horizontal planes of the spinal cord. Removal of AVM was given up in one case because of its possible involvement of the anterior spinal artery and central artery shown by CT scan. Removal of AVMs were performed in other two cases. A lateral approach was tried in one case with the AVM located in C 1 -C 2 level, in which CT scan revealed not only an intramedullary but the associated extramedullary AVM in ventrolateral surface of the spinal cord. This operative approach was found to involve less bone removal and markedly reduce spinal cord manipulation necessary to deal with ventrally situated high cervical lesions, compared with a posterior approach with laminectomy. (author)

  8. Long-Term Treatment Sequelae After External Beam Irradiation With or Without Hormonal Manipulation for Adenocarcinoma of the Prostate: Analysis of Radiation Therapy Oncology Group Studies 85-31, 86-10, and 92-02

    International Nuclear Information System (INIS)

    Lawton, Colleen A.; Bae, Kyoungwha; Pilepich, Miljenko; Hanks, Gerald; Shipley, William

    2008-01-01

    Purpose: Late gastrointestinal (GI) and genitourinary (GU) morbidity from external beam irradiation used to treat adenocarcinoma of the prostate continue to be a concern of physicians and patients alike. In addition, for locally advanced/high-risk cancer, the appropriate use of hormonal manipulation in addition to radiation therapy (RT) may increase toxicity. We analyzed three large Radiation Therapy Oncology Group (RTOG) studies (85-31, 86-10, and 92-02) to try to address these issues. Methods and Materials: A total of 2,922 patients were accrued with a median follow-up of 10.3 years for surviving patients. The RTOG scoring scheme was used to assess GI, GU, and other toxicities. Toxicity reported was Grade 3 or higher late toxicity. Patient toxicity level was assessed by study and by treatment type combining RT only vs. RT + short-course hormone therapy (STH) vs. RT + long-term hormone therapy (LTH). Results: Multivariate analysis reveals that age >70 was statistically significantly associated with a decrease in late any Grade 3+ toxicity (hazard ratio [HR] = 0.78, p = 0.0476) adjusted for treatment type. Comparing treatment type, patients treated with RT+STH had a statistically significant lower probability of Grade 3+ GI, GU, and other toxicity compared with RT alone (p = .00006; p = 0.0037; p = 0.0127, respectively). Patients treated with RT+LTH had a statistically significant lower probability of Grade 3+ GU toxicity compared with RT alone (p = 0.023). Conclusions: These data show that external beam radiation therapy remains a safe option for locally advanced/high-risk prostate cancer, and the use of hormonal manipulation does appear to be protective for GU and GI toxicity depending upon length of treatment

  9. Single-Fraction Versus 5-Fraction Radiation Therapy for Metastatic Epidural Spinal Cord Compression in Patients With Limited Survival Prognoses: Results of a Matched-Pair Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Rades, Dirk, E-mail: Rades.Dirk@gmx.net [Department of Radiation Oncology, University Hospital Lubeck, Lubeck (Germany); Huttenlocher, Stefan [Department of Radiation Oncology, University Hospital Lubeck, Lubeck (Germany); Šegedin, Barbara; Perpar, Ana [Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana (Slovenia); Conde, Antonio J.; Garcia, Raquel [Department of Radiation Oncology, Consorcio Hospital Provincial de Castellón, Castellón (Spain); Veninga, Theo [Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg (Netherlands); Stalpers, Lukas J.A. [Department of Radiation Oncology, Academic Medical Center, Amsterdam (Netherlands); Cacicedo, Jon [Department of Radiation Oncology, Cruces University Hospital, Barakaldo, Vizcaya (Spain); Rudat, Volker [Department of Radiation Oncology, Saad Specialist Hospital, Al Khobar (Saudi Arabia); Schild, Steven E. [Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona (United States)

    2015-10-01

    Purpose: This study compared single-fraction to multi-fraction short-course radiation therapy (RT) for symptomatic metastatic epidural spinal cord compression (MESCC) in patients with limited survival prognosis. Methods and Materials: A total of 121 patients who received 8 Gy × 1 fraction were matched (1:1) to 121 patients treated with 4 Gy × 5 fractions for 10 factors including age, sex, performance status, primary tumor type, number of involved vertebrae, other bone metastases, visceral metastases, interval between tumor diagnosis and MESCC, pre-RT ambulatory status, and time developing motor deficits prior to RT. Endpoints included in-field repeated RT (reRT) for MESCC, overall survival (OS), and impact of RT on motor function. Univariate analyses were performed with the Kaplan-Meier method and log-rank test for in-field reRT for MESCC and OS and with the ordered-logit model for effect of RT on motor function. Results: Doses of 8 Gy × 1 fraction and 4 Gy × 5 fractions were not significantly different with respect to the need for in-field reRT for MESCC (P=.11) at 6 months (18% vs 9%, respectively) and 12 months (30% vs 22%, respectively). The RT regimen also had no significant impact on OS (P=.65) and post-RT motor function (P=.21). OS rates at 6 and 12 months were 24% and 9%, respectively, after 8 Gy × 1 fraction versus 25% and 13%, respectively, after 4 Gy × 5 fractions. Improvement of motor function was observed in 17% of patients after 8 Gy × 1 fraction and 23% after 4 Gy × 5 fractions, respectively. Conclusions: There were no significant differences with respect to need for in-field reRT for MESCC, OS, and motor function by dose fractionation regimen. Thus, 8 Gy × 1 fraction may be a reasonable option for patients with survival prognosis of a few months.

  10. Spinal Cord Injury 101

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    Full Text Available ... Abuse and Spinal Cord Injury Allen Heinemann, PhD How Peer Counseling Works Julie Gassaway, MS, RN Pediatric Injuries Pediatric Spinal ... What is a spinal cord injury? play_arrow How does the spinal cord work? play_arrow Why is the level of a ...

  11. 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.

  12. Magnetic resonance imaging of spinal diseases

    International Nuclear Information System (INIS)

    Nakatani, Mariko; Sekiya, Toru; Harada, Junta; Kawakami, Kenji; Tada, Shimpei

    1985-01-01

    Twenty-two patients were examined to determine the clinical value of magnetic resonance imaging (MRI) in the spinal disease. Using different pulse sequences T 1 value was obtained from 38 spines; the result showed that increased T 1 value indicated spinal marrow abnormalities. A comparative study of MRI and bone scintigraphy was performed in 18 patients. Although it was not feasible to evaluate effect of therapy in metastatic disease by MRI, diffuse bone marrow disease, such as diffuse bone marrow metastases and blood dyscrasia could be detected by MRI. This limited study will suggest applicability of MRI in the spinal disease. (author)

  13. Use of the SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness.

    Science.gov (United States)

    Fraix, Marcel; Gordon, Ashlynn; Graham, Victoria; Hurwitz, Eric; Seffinger, Michael A

    2013-05-01

    Dizziness is the third most common complaint among outpatients and the most common complaint in patients aged 75 years or older. It can be incapacitating for patients, affecting both productivity and quality of life. To evaluate the effect of osteopathic manipulative treatment (OMT) for spinal somatic dysfunction in patients with dizziness lasting longer than 3 months. A prospective clinical cohort study that took place in 2011. Department of Physical Therapy laboratory at the Western University of Health Sciences College of Osteopathic Medicine in Pomona, California. Sixteen participants (2 male, 14 female; mean [range] age, 49 [13-75] years) with dizziness lasting at least 3 months (mean duration of symptoms, 84 months) and spinal somatic dysfunction, but no history of known stroke or brain disease, were recruited from the local community and evaluated for postural balance control before, immediately after, and 1 week after OMT. Four osteopathic physicians board certified in neuromusculoskeletal medicine/osteopathic manipulative medicine provided OMT, including muscle energy; high-velocity, low-amplitude; counterstrain; myofascial release; balanced ligamentous release; and cranial OMT techniques. Outcomes were assessed with the SMART Balance Master (NeuroCom), a validated instrument that provides graphic and quantitative analyses of sway and balance, and the Dizziness Handicap Inventory (DHI), a self-assessment inventory designed to assess precipitating physical factors associated with dizziness and functional and emotional consequences of vestibular disease. Paired t tests, performed to assess changes in mean composite scores for all challenge tests, revealed that balance was significantly improved both immediately and 1 week after OMT (both P<.001), with no significant difference between immediate and 1-week post-OMT scores (P=.20). The DHI scores, both total and subscale, improved significantly after OMT (P<.001), and changes in composite and DHI scores were

  14. 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.

  15. Monitoring cervical manipulations (MCM) : design of a prospective cohort study

    NARCIS (Netherlands)

    Kranenburg, Rik; van der Schans, Cees; Schmitt, M.A.; Luijckx, Gert Jan

    Introduction: Major Adverse Events (MAE) following Cervical Spinal Manipulations (CSM) have been described anecdotally and are frequently discussed. Until now, exact incidence rates are unknown. Furthermore, there are doubts concerning the factors which may play a role in the occurrence of MAE.

  16. The effect of lumbosacral manipulation on growing pains

    Directory of Open Access Journals (Sweden)

    Dawid de Beer

    2015-06-01

    Conclusion: The results from this study, specifically the feedback from parent(s/guardians(s and the pain diaries, indicated that spinal manipulation is beneficial in the treatment of growing pains. The results also showed that other methods of treating growing pains, such as simple leg rubs, may also bring relief.

  17. Spinal stenosis

    International Nuclear Information System (INIS)

    Beale, S.; Pathria, M.N.; Ross, J.S.; Masaryk, T.J.; Modic, M.T.

    1988-01-01

    The authors studied 50 patients who had spinal stenosis by means of MR imaging. All patients had undergone myelography and CT. Thirty patients underwent surgery. MR imaging included T1-weighted spin echo sequences with repetition time = 600 msec, echo time = 20 (600/20) sagittal and axial sections 4 mm thick with 2 mm gap. T2-weighted 2,000/60 axial images were obtained on 14 patients. Examinations were retrospectively evaluated for central stenosis, lateral recess narrowing, and foraminal encroachment. Measurements of sagittal, interpedicular, interfacet, and recess dimensions were made at L3-5. On MR images, 20 patients had single-level and 30 had multiple-level stenosis. There was excellent agreement between modalities with central canal stenosis, but a discrepancy in six patients with bony foraminal stenosis. MR imaging was an accurate method for assessment of lumbar stenosis, but CT appears marginally better for detection of bony foraminal stenosis in certain cases

  18. Thoracic mobilisation and periscapular soft tissue manipulations in the management of chronic Prolapsed Intervertebral Disc (PIVD - An innovative manual therapy approach

    Directory of Open Access Journals (Sweden)

    Raj Kiran

    2017-10-01

    Full Text Available Background The most common cause of CLBP is discogenic lower back pain. Researches haveshown that connective tissue remodelling occurs in CLBP and thoracic spinal mobility and thoracolumbar mobility have higher correlations with LBP. Aims To see the effect of upper back fascia and periscapular muscles stretching and thoracic mobilisation to reduce symptoms in subjects with CLBP due to lumbar disk herniation. Methods A total of 40 subjects with CLBP due to Prolapsed Intervertebral Disc (PIVD were recruited and randomly distributed in two groups. Group 1 was given stretching of upper back fascia and periscapular muscles and thoracic mobilization along with conventional exercises (Cyriax listing correction -I followed by repeated McKenzie back extension exercise and Core muscle strengthening. Group 2 received only conventional exercises. Outcome Measures: visual analog scale, Oswestry Disability Index and Modified Schober's Test. Measurements were taken before and after three weeks of treatment, for five days/week. Results Overall results of the study, both Group 1 and Group 2 showed improvement in pain, function and lumbar Range of Motion (ROM after three weeks of intervention. However, Group 1 improved significantly to a greater extent in pain, ROM and function than the Group 2. Conclusion Stretching of periscapular muscles and fascia of the upper back and mobilisation of upper thoracic spine is found to be effective for the management of chronic low back pain due to PIVD.

  19. Cauda equina syndrome in patients undergoing manipulation of the lumbar spine

    NARCIS (Netherlands)

    Haldeman, S.; Rubinstein, S M

    1992-01-01

    Cauda equina syndrome has been implicated as a potential complication of spinal manipulation. A review of the literature from 1911 to 1989 revealed ten reported cases of cauda equina syndrome in patients undergoing manipulation without anesthesia. This article presents three new cases where a

  20. Currency Manipulation versus Current Account Manipulation

    OpenAIRE

    Junning Cai

    2005-01-01

    It is said that a country’s currency peg can become currency manipulation representing protracted government intervention in the foreign exchange market that gives it unfair competitive advantage in international trade yet prevents effective balance of payments in its trade partners. Regarding this widespread fallacy, this paper explains why currency peg is not currency manipulation even when it keeps a country’s currency undervalued. We clarify that 1) government is inherently a major player...

  1. Spinal trauma. An imaging approach

    International Nuclear Information System (INIS)

    Cassar-Pullicino, V.N.; Imhof, H.

    2006-01-01

    The diagnosis of trauma to the spine - where the slightest oversight may have catastrophic results - requires a thorough grasp of the spectrum of resultant pathology as well as the imaging modalities used in making an accurate diagnosis. In Spinal Trauma, the internationally renowned team of experts provides a comprehensive, cutting-edge exposition of the current vital role of imaging in the diagnosis and treatment of injuries to the axial skeleton. Beginning with a valuable clinical perspective of spinal trauma, the book offers the reader a unique overview of the biomechanics underlying the pathology of cervical trauma. Acute trauma topics include: - Optimization of imaging modalities - Malalignment - signs and significance - Vertebral fractures - detection and implications - Classification of thoraco-lumbar fractures - rationale and relevance - Neurovascular injury. Distilling decades of clinical and teaching expertise, the contributors further discuss the current role of imaging in special focus topics, which include: - The pediatric spine - Sports injuries - The rigid spine - Trauma in the elderly - Vertebral collapse, benign and malignant - Spinal trauma therapy - Vertebral fractures and osteoporosis - Neuropathic spine. All throughout the book, the focus is on understanding the injury, and its implications and complications, through 'an imaging approach'. Lavishly illustrated with hundreds of superb MR images and CT scans, and clear full-color drawings, the authors conclude with a look into the future, defining clinical trends and research directions. Spinal Trauma - with its broad scope, practical imaging approach, and current focus - is designed to enhance confidence and accuracy, making it essential reading for clinicians and radiologists at all levels. (orig.)

  2. Spinal cord toxoplasmosis in AIDS

    International Nuclear Information System (INIS)

    Carteret, M.; Petit, E.; Granat, O.; Marichez, M.; Gilquin, J.

    1995-01-01

    Toxoplasmosis is the most common brain parasitic infection in acquired immunodeficiency syndrome (AIDS). Spinal cord localizations are still rare (2 cases with cerebral involvement, 2 cases without). A case of both spinal cord and cerebral involvement is reported. Magnetic resonance imaging (MR imaging) was performed because of sensory level (L 1). A focal conus medullaris enlargement was seen, iso intense on T 1 weighted images. This lesion was hyperintense on T 2 weighted sequence, and was homogeneously enhanced after Gadolinium on T 1 weighted images. A medullary oedema was noted. A toxoplasmosis treatment was initiated, without cortico therapy. MR imaging performed one month later (D 30), while important clinical improvements were seen, pointed out normal thickness of conus medullaris, without enhancement after Gadolinium. Disease lesions in AIDS with focal spinal cord processes are reviewed, and diagnostic work-up is discussed. Spinal cord single lesion, associated or not with brain involvements should be treated as a toxoplasmic infection, with MR imaging follow up. This work up should avoid medullary biopsy, still required in case of treatment failure. Cerebral involvements, with multiples lesions can mask medullary localization. (authors). 8 refs., 2 figs

  3. Billing and coding for osteopathic manipulative treatment.

    Science.gov (United States)

    Snider, Karen T; Jorgensen, Douglas J

    2009-08-01

    Some osteopathic physicians are not properly reimbursed by insurance companies after providing osteopathic manipulative treatment (OMT) to their patients. Common problems associated with lack of reimbursements include insurers bundling OMT with the standard evaluation and management service and confusing OMT with chiropractic manipulative treatment or physical therapy services. The authors suggest methods of appeal for denied reimbursement claims that will also prevent future payment denials.

  4. 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

  5. The CT findings of spinal tuberculosis

    International Nuclear Information System (INIS)

    Li Yizhao; Liu Jianming; Ke Yong; XiaoYong; Liu Rihua

    2002-01-01

    Objective: To investigate the CT diagnosis and differential diagnosis of spinal tuberculosis. Methods: CT manifestations were retrospectively analyzed in 43 cases of spinal tuberculosis. This series included 24 males and 19 females, aged 10-57 years. 15 cases were confirmed by operation and pathology; 18 cases were confirmed by biopsy and 10 cases were cured by antituberculosis therapy. Results: The CT manifestations of spinal tuberculosis were: 1) mottling, patchy, caved or faveolate bone destructions (43/43 cases); 2) elevated density of the involved vertebrae (13/43 cases); 3) destruction of intervertebral discs (32/43 cases); 4) formation of sequester (30/43 cases); 5) para-vertebral abscess, often with calcification (38/43 cases); 6) osseous vertebral canal narrowing (8/43 cases); 7) vertebrae compression (28/43 cases). Conclusion: CT scan is a valuable modality for the diagnosis and differential diagnosis of spinal tuberculosis

  6. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... About Media Donate Spinal Cord Injury Medical Expert Videos ... Home Kim Eberhardt Muir, MS Coping with a New Injury Robin Dorman, PsyD Sex and Fertility After Spinal Cord Injury Diane M. ...

  7. Spinal Cord Dysfunction (SCD)

    Data.gov (United States)

    Department of Veterans Affairs — The Spinal Cord Dysfunction (SCD) module supports the maintenance of local and national registries for the tracking of patients with spinal cord injury and disease...

  8. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... OT Anne Bryden, OT The Role of the Social Worker after Spinal Cord Injury Patti Rogers, SW Marguerite ... play_arrow What are the latest developments in the use of electrical stimulation for spinal ...

  9. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... with SCI Personal Experiences by Topic Resources Peer Counseling Blog About Media Donate close search Understanding Spinal ... with SCI Personal Experiences by Topic Resources Peer Counseling Blog About Media Donate Spinal Cord Injury Medical ...

  10. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Injury Facts and Figures Care and Treatment After SCI Spinal Cord Injury Rehabilitation Pediatric Spinal Cord Injuries Video Library SCI Medical Experts People Living with SCI Personal Experiences ...

  11. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Cord Injury Rehabilitation Pediatric Spinal Cord Injuries Video Library SCI Medical Experts People Living with SCI Personal ... Cord Injury Rehabilitation Pediatric Spinal Cord Injuries Video Library SCI Medical Experts People Living with SCI Personal ...

  12. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... of spinal cord injuries? play_arrow What does stem-cell research on animals tell us? play_arrow When can we expect stem-cell treatments to become available for spinal cord injuries? ...

  13. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... spinal cord injuries? play_arrow What does stem-cell research on animals tell us? play_arrow When can we expect stem-cell treatments to become available for spinal cord injuries? ...

  14. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Resources Peer Counseling Blog About Media Donate close search Understanding Spinal Cord Injury What is a Spinal ... health care products or services, or control the information found on external websites. The Hill Foundation is ...

  15. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Spinal Cord Injuries Video Library SCI Medical Experts People Living with SCI Personal Experiences by Topic Resources ... Spinal Cord Injuries Video Library SCI Medical Experts People Living with SCI Personal Experiences by Topic Resources ...

  16. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... play_arrow What are the chances of regaining feeling and mobility after a spinal cord injury? play_arrow How long does it usually take for feeling and movement to return after a spinal cord ...

  17. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Disabilities Photography by Rona Talcott Website by Mobile Marketing LLC Understanding Spinal Cord Injury About Us Expert Videos Contact Us Personal Experience Videos Blog Videos By Topic Media Resources Donate to support families facing spinal cord ...

  18. Spinal cord stimulation

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007560.htm Spinal cord stimulation To use the sharing features on this page, please enable JavaScript. Spinal cord stimulation is a treatment for pain that uses ...

  19. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Spinal Cord Injury 101 David Chen, MD Preventing Pressure Sores Mary Zeigler, MS Transition from Hospital to ... a spinal cord injury? play_arrow Why are high-dose steroids often used right after an injury? ...

  20. Spinal segmental dysgenesis

    Directory of Open Access Journals (Sweden)

    N Mahomed

    2009-06-01

    Full Text Available Spinal segmental dysgenesis is a rare congenital spinal abnormality , seen in neonates and infants in which a segment of the spine and spinal cord fails to develop normally . The condition is segmental with normal vertebrae above and below the malformation. This condition is commonly associated with various abnormalities that affect the heart, genitourinary, gastrointestinal tract and skeletal system. We report two cases of spinal segmental dysgenesis and the associated abnormalities.

  1. Interventional MR-Mammography: manipulator-assisted large core biopsy and interstitial laser therapy of tumors of the female breast; Interventionelle MR-Mammographie: Manipulatorgestuetzte Biopsie und interstitielle Lasertherapie von Tumoren der weiblichen Brust

    Energy Technology Data Exchange (ETDEWEB)

    Pfleiderer, S.O.R.; Reichenbach, J.R.; Wurdinger, S.; Marx, C.; Freesmeyer, M.G.; Kaiser, W.A. [Inst. fuer Diagnostische und Interventionelle Radiologie, Friedrich-Schiller-Univ. Jena (Germany); Vagner, J.; Fischer, H. [Inst. fuer Medizintechnik und Biophysik, Forschungszentrum Karlsruhe (Germany); Schneider, A. [Klinik fuer Frauenheilkunde, Friedrich-Schiller-Univ. Jena (Germany)

    2003-07-01

    The present study investigated the clinical application of magnetic resonance (MR)-guided breast interventions, such as manipulator-assisted large core breast biopsy (LCBB) inside a 1.5 T whole-body magnet and MR-guided interstitial laser therapy (ILT). Sixteen patients underwent LCBB and 1 additional patient underwent 4 sessions of ILT of a recurrent undifferentiated lymph node metastasis in the axilla using a Nd-YAG laser (1064 nm). Temperature changes of the tumor tissue during ILT were monitored using phase images of a gradient echo sequence (GRE) (TR/TE/FA = 25/12/30). In 5 patients the biopsy findings were histopathologically confirmed after open surgery. In 3 patients, the biopsy missed one tubular and one ductal carcinoma; one invasive carcinoma was underestimated. Eight patients with benign findings are still in the follow-up period. The heating zone during ILT was well delineated on subtracted phase images. No severe adverse events were observed with LCBB or ILT. MR-guided breast biopsies are feasible with the manipulator system inside a whole-body 1.5 Tesla MR scanner. GRE information is suitable for therapy monitoring during ILT within the tumor. Further studies are necessary to evaluate the accuracy of the manipulator system and the efficacy of ILT in the treatment of breast lesions. (orig.) [German] Die klinische Anwendung MR-gestuetzter Interventionen an der Mamma wie die roboterassistierte Brustbiopsie innerhalb eines Ganzkoerpertomographen oder die kernspintomographisch kontrollierte interstitielle Lasertherapie (ILT) wurden untersucht. 16 Patientinnen unterzogen sich einer Brustbiopsie. Eine weitere Patientin wurde in insgesamt 4 Sitzungen mit einem Nd-YAG-Laser (1064 nm) an einem undifferenzierten axillaeren Lymphknotenrezidiv eines Mammakarzinoms behandelt. Temperaturaenderungen im Tumor waehrend der ILT wurden mit Hilfe von Phasenbildern einer Gradientenechosequenz (GRE) (TR/TE/FA = 25/12/30) visualisiert. Bei 5 Patientinnen wurde der

  2. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... the spinal cord work? play_arrow Why is the level of a spinal cord injury important? play_arrow What role does “compression” play in a spinal cord injury? play_arrow Why are high-dose steroids often used right after an injury? play_arrow What is meant ...

  3. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... arrow What is the “Spinal Cord Injury Model Systems” program? play_arrow What are the most promising new treatments for spinal cord injuries? play_arrow What are the latest developments in the use of electrical stimulation for spinal cord injuries? play_arrow ...

  4. Spinal Cord Injuries

    Science.gov (United States)

    ... forth between your body and your brain. A spinal cord injury disrupts the signals. Spinal cord injuries usually begin with a blow that fractures or ... down on the nerve parts that carry signals. Spinal cord injuries can be complete or incomplete. With a complete ...

  5. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... injury? play_arrow How does the spinal cord work? play_arrow Why is the level of a spinal cord injury important? play_arrow What role does “compression” play in a spinal cord injury? play_arrow Why are high-dose steroids often used right after an injury? play_arrow What is meant ...

  6. Effects of chronic shoulder pain on quality of life and occupational engagement in the population with chronic spinal cord injury: preparing for the best outcomes with occupational therapy.

    Science.gov (United States)

    Silvestri, Jennifer

    2017-01-01

    Purpose To examine the implications of chronic shoulder pain on quality of life and occupational engagement in spinal cord injury (SCI). The Ecology of Human Performance Model and Self-Efficacy Theory will be used to further examine the interplay of shoulder pain, quality of life and engagement in this population. Method Analysis of literature. Results Persons with SCI have a high prevalence of shoulder pain and injury, affecting 37-84% of analysed studies; chronic pain limits occupational engagement and decreases quality of life. Remediation of pain provides improved occupational engagement, functional independence and quality of life in those with high self-efficacy and low depression. Conclusion Shoulder pain is a serious complication following SCI and the Ecology of Human Performance Model and Self-Efficacy Theory can be utilized in conjunction for a framework to evaluate, treat and prevent shoulder pain and its devastating effects on occupational engagement and quality of life in the spinal cord injured population. Thereafter, rehabilitation professionals will have a greater understanding of these interactions to serve as a guide for evaluation and intervention planning to promote optimal occupational engagement through limiting the experiences of occupational injustices for those with SCI and shoulder pain. Implications for Rehabilitation Musculoskeletal pain at the shoulder joint and depression are common complications following spinal cord injury that limit occupational engagement and decrease quality of life. To increase engagement and quality of life in this population, treatments need to address all factors including the under-lying psychosocial instead of task and environment modification alone. The Ecology of Human Performance Model and Self-efficacy Theory are effective frameworks that can be used for evaluation, treatment planning and outcome measurement to maximize occupational engagement and quality of life.

  7. Getting Manipulative about Math.

    Science.gov (United States)

    Scheer, Janet K.; And Others

    1984-01-01

    Math manipulatives that are made from inexpensive, common items help students understand basic mathematics concepts. Learning activities using Cheerios, jellybeans, and clay as teaching materials are suggested. (DF)

  8. Manipulators in teleoperation

    International Nuclear Information System (INIS)

    Hamel, W.R.

    1985-01-01

    Teleoperated manipulators represent a mature technology which has evolved over nearly 40 years of applications experience. The wide range of manipulator concepts developed thus far reflect differing applications, priorities, and philosophies. The technology of teleoperated manipulators is in a rapid state of change (just as are industrial robotics) fueled by microelectronics and materials advances. Large strides in performance and dexterity are now practical and advantageous. Even though improved controls and sensory feedback will increase functionality, overall costs should be reduced as manipulator fabrication and assembly labor costs are reduced through improved manufacturing technology. As these advances begin to materialize, broader applications in nonnuclear areas should occur

  9. social management of patients with spinal cord injury

    African Journals Online (AJOL)

    Mugumbate

    Pre-test/post-test quasi experimental research design was adopted for the ... study established that music therapy significantly reduced the pain experienced by spinal .... did not reduce the pain perception of stroke victims and surgery patients.

  10. Trauma: Spinal Cord Injury.

    Science.gov (United States)

    Eckert, Matthew J; Martin, Matthew J

    2017-10-01

    Injuries to the spinal column and spinal cord frequently occur after high-energy mechanisms of injury, or with lower-energy mechanisms, in select patient populations like the elderly. A focused yet complete neurologic examination during the initial evaluation will guide subsequent diagnostic procedures and early supportive measures to help prevent further injury. For patients with injury to bone and/or ligaments, the initial focus should be spinal immobilization and prevention of inducing injury to the spinal cord. Spinal cord injury is associated with numerous life-threatening complications during the acute and long-term phases of care that all acute care surgeons must recognize. Published by Elsevier Inc.

  11. Human spinal motor control

    DEFF Research Database (Denmark)

    Nielsen, Jens Bo

    2016-01-01

    Human studies in the past three decades have provided us with an emerging understanding of how cortical and spinal networks collaborate to ensure the vast repertoire of human behaviors. We differ from other animals in having direct cortical connections to spinal motoneurons, which bypass spinal...... the central motor command by opening or closing sensory feedback pathways. In the future, human studies of spinal motor control, in close collaboration with animal studies on the molecular biology of the spinal cord, will continue to document the neural basis for human behavior. Expected final online...

  12. International Spinal Cord Injury

    DEFF Research Database (Denmark)

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

    2015-01-01

    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......: A committee of experts was established to select and define data elements. The data set was then disseminated to the appropriate committees and organizations for comments. All suggested revisions were considered and both the International Spinal Cord Society and the American Spinal Injury Association endorsed...... spinal intervention and procedure is coded (variables 1 through 7) and the spinal segment level is described (variables 8 and 9). Sample clinical cases were developed to illustrate how to complete it. CONCLUSION: The International SCI Spinal Interventions and Surgical Procedures Basic Data Set...

  13. Master-slave manipulator

    International Nuclear Information System (INIS)

    Haaker, L.W.; Jelatis, D.G.

    1981-01-01

    A remote control master-slave manipulator for performing work on the opposite side of a barrier wall, is described. The manipulator consists of a rotatable horizontal support adapted to extend through the wall and two longitudinally extensible arms, a master and a slave, pivotally connected one to each end of the support. (U.K.)

  14. In Praise of Manipulation

    NARCIS (Netherlands)

    Dowding, Keith; Van Hees, Martin

    Many theorists believe that the manipulation of voting procedures is a serious problem. Accordingly, much of social choice theory examines the conditions under which strategy-proofness can be ensured, and what kind of procedures do a better job of preventing manipulation. This article argues that

  15. Cell manipulation in microfluidics

    International Nuclear Information System (INIS)

    Yun, Hoyoung; Kim, Kisoo; Lee, Won Gu

    2013-01-01

    Recent advances in the lab-on-a-chip field in association with nano/microfluidics have been made for new applications and functionalities to the fields of molecular biology, genetic analysis and proteomics, enabling the expansion of the cell biology field. Specifically, microfluidics has provided promising tools for enhancing cell biological research, since it has the ability to precisely control the cellular environment, to easily mimic heterogeneous cellular environment by multiplexing, and to analyze sub-cellular information by high-contents screening assays at the single-cell level. Various cell manipulation techniques in microfluidics have been developed in accordance with specific objectives and applications. In this review, we examine the latest achievements of cell manipulation techniques in microfluidics by categorizing externally applied forces for manipulation: (i) optical, (ii) magnetic, (iii) electrical, (iv) mechanical and (v) other manipulations. We furthermore focus on history where the manipulation techniques originate and also discuss future perspectives with key examples where available. (topical review)

  16. Manipulator comparative testing program

    International Nuclear Information System (INIS)

    Draper, J.V.; Handel, S.J.; Sundstrom, E.; Herndon, J.N.; Fujita, Y.; Maeda, M.

    1986-01-01

    The Manipulator Comparative Testing Program examined differences among manipulator systems from the United States and Japan. The manipulator systems included the Meidensha BILARM 83A, the Model M-2 of Central Research Laboratories Division of Sargent Industries (CRL), and the GCA Corporation PaR Systems Model 6000. The site of testing was the Remote Operations Maintenance Demonstration (ROMD) facility, operated by the Fuel Recycle Division in the Consolidated Fuel Reprocessing Program at the Oak Ridge National Laboratory (ORNL). In all stages of testing, operators using the CRL Model M-2 manipulator had consistently lower times to completion and error rates than they did using other machines. Performance was second best with the Meidensha BILARM 83A in master-slave mode. Performance with the BILARM in switchbox mode and the PaR 6000 manipulator was approximately equivalent in terms of criteria recorded in testing. These data show no impact of force reflection on task performance

  17. New trends in spinal cord tissue engineering

    Czech Academy of Sciences Publication Activity Database

    Kubinová, Šárka

    2015-01-01

    Roč. 10, č. 2 (2015), s. 129-145 ISSN 1479-6708 R&D Projects: GA MŠk(CZ) LO1309 Institutional support: RVO:68378041 Keywords : biomaterial * cell therapy * regenerative medicine * spinal cord injury * stem cells scaffold * tissue engineering Subject RIV: FH - Neurology

  18. Diffusion tensor imaging in spinal cord injury

    International Nuclear Information System (INIS)

    Kamble, Ravindra B; Venkataramana, Neelam K; Naik, Arun L; Rao, Shailesh V

    2011-01-01

    To assess the feasibility of spinal tractography in patients of spinal cord injury vs a control group and to compare fractional anisotropy (FA) values between the groups. Diffusion tensor imaging (DTI) was performed in the spinal cord of 29 patients (18 patients and 11 controls). DTI was done in the cervical region if the cord injury was at the dorsal or lumbar region and in the conus region if cord injury was in the cervical or dorsal region. FA was calculated for the patients and the controls and the values were compared. The mean FA value was 0.550±0.09 in the control group and 0.367±0.14 in the patients; this difference was statistically significant (P=0.001). Spinal tractography is a feasible technique to assess the extent of spinal cord injury by FA, which is reduced in patients of spinal cord injury, suggesting possible Wallerian degeneration. In future, this technique may become a useful tool for assessing cord injury patients after stem cell therapy, with improvement in FA values indicating axonal regeneration

  19. Adverse Events of Massage Therapy in Pain-Related Conditions: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Ping Yin

    2014-01-01

    Full Text Available Pain-related massage, important in traditional Eastern medicine, is increasingly used in the Western world. So the widening acceptance demands continual safety assessment. This review is an evaluation of the frequency and severity of adverse events (AEs reported mainly for pain-related massage between 2003 and 2013. Relevant all-languages reports in 6 databases were identified and assessed by two coauthors. During the 11-year period, 40 reports of 138 AEs were associated with massage. Author, year of publication, country of occurrence, participant related (age, sex or number of patients affected, the details of manual therapy, and clinician type were extracted. Disc herniation, soft tissue trauma, neurologic compromise, spinal cord injury, dissection of the vertebral arteries, and others were the main complications of massage. Spinal manipulation in massage has repeatedly been associated with serious AEs especially. Clearly, massage therapies are not totally devoid of risks. But the incidence of such events is low.

  20. Adolescent idiopathic scoliosis (AIS, environment, exposome and epigenetics: a molecular perspective of postnatal normal spinal growth and the etiopathogenesis of AIS with consideration of a network approach and possible implications for medical therapy

    Directory of Open Access Journals (Sweden)

    Burwell R Geoffrey

    2011-12-01

    lead through screening, genetic, epigenetic, biochemical, metabolic phenotypes and pharmacogenomic research to identify susceptible individuals at risk and modulate abnormal molecular pathways of AIS. The potential of epigenetic-based medical therapy for AIS cannot be assessed at present, and must await new research derived from the evaluation of epigenetic concepts of spinal growth in health and deformity. The tenets outlined here for AIS are applicable to other musculoskeletal growth disorders including infantile and juvenile idiopathic scoliosis.

  1. Manipulation, salience, and nudges.

    Science.gov (United States)

    Noggle, Robert

    2018-03-01

    Cass Sunstein and Richard Thaler recommend helping people make better decisions by employing 'nudges', which they define as noncoercive methods of influencing choice for the better. Not surprisingly, healthcare practitioners and public policy professionals have become interested in whether nudges might be a promising method of improving health-related behaviors without resorting to heavy-handed methods such as coercion, deception, or government regulation. Many nudges seem unobjectionable as they merely improve the quality and quantity available for the decision-maker. However, other nudges influence decision-making in ways that do not involve providing more and better information. Nudges of this sort raise concerns about manipulation. This paper will focus on noninformational nudges that operate by changing the salience of various options. It will survey two approaches to understanding manipulation, one which sees manipulation as a kind of pressure, and one that sees it as a kind of trickery. On the pressure view, salience nudges do not appear to be manipulative. However, on the trickery view (which the author favors), salience nudges will be manipulative if they increase the salience so that it is disproportionate to that fact's true relevance and importance for the decision at hand. By contrast, salience nudges will not be manipulative if they merely highlight some fact that is true and important for the decision at hand. The paper concludes by providing examples of both manipulative and nonmanipulative salience nudges. © 2017 John Wiley & Sons Ltd.

  2. Manipulators for production and research

    International Nuclear Information System (INIS)

    Munro, Ian

    1987-01-01

    The development of caves or cells and master-slave manipulators to handle radioactive materials is discussed. Some of the most recent advances are described. A manipulator arm, a master-slave manipulator and a servomanipulator mounted on a manipulator are illustrated. Future developments are discussed - these include resolved tip control for the manipulator. (UK)

  3. Powered manipulator control arm

    International Nuclear Information System (INIS)

    Le Mouee, Theodore; Vertut, Jean; Marchal, Paul; Germon, J.C.; Petit, Michel

    1975-01-01

    A remote operated control arm for powered manipulators is described. It includes an assembly allowing several movements with position sensors for each movement. The number of possible arm movements equals the number of possible manipulator movements. The control systems may be interrupted as required. One part of the arm is fitted with a system to lock it with respect to another part of the arm without affecting the other movements, so long as the positions of the manipulator and the arm have not been brought into complete coincidence. With this system the locking can be ended when complete concordance is achieved [fr

  4. Simulation of robot manipulators

    International Nuclear Information System (INIS)

    Kress, R.L.; Babcock, S.M.; Bills, K.C.; Kwon, D.S.; Schoenwald, D.A.

    1995-01-01

    This paper describes Oak Ridge National Laboratory's development of an environment for the simulation of robotic manipulators. Simulation includes the modeling of kinematics, dynamics, sensors, actuators, control systems, operators, and environments. Models will be used for manipulator design, proposal evaluation, control system design and analysis, graphical preview of proposed motions, safety system development, and training. Of particular interest is the development of models for robotic manipulators having at least one flexible link. As a first application, models have been developed for the Pacific Northwest Laboratories' Flexible Beam Testbed which is a one-Degree-Of-Freedom, flexible arm with a hydraulic base actuator. Initial results show good agreement between model and experiment

  5. The direct manipulation shell

    International Nuclear Information System (INIS)

    Allen, M.E.; Christiansen, M.

    1992-01-01

    Accelerator controls systems provide parameter display pages which allow the operator to monitor and manipulate selected control points in the system. Display pages are generally implemented as either hand-crafted, purpose-built programs; or by using a specialized display page layout tool. These two methods of display page development exhibit the classic trade-off between functionality vs. ease of implementation. In the Direct Manipulation Shell we approach the process of developing a display page in a manifestly object-oriented manner. This is done by providing a general framework for interactively instantiating and manipulating display objects. (author)

  6. Drug-resistant spinal tuberculosis

    Directory of Open Access Journals (Sweden)

    Anil K Jain

    2018-01-01

    Full Text Available Drug-resistant spinal tuberculosis (TB is an emerging health problem in both developing and developed countries. In this review article, we aim to define management protocols for suspicion, diagnosis, and treatment of such patients. Spinal TB is a deep-seated paucibacillary lesion, and the demonstration of acid-fast bacilli on Ziehl-Neelsen staining is possible only in 10%–30% of cases. Drug resistance is suspected in patients showing the failure of clinicoradiological improvement or appearance of a fresh lesion of osteoarticular TB while on anti tubercular therapy (ATT for a minimum period of 5 months. The conventional culture of Mycobacterium tuberculosis remains the gold standard for both bacteriological diagnosis and drug sensitivity testing (DST; however, the high turn around time of 2–6 weeks for detection with added 3 weeks for DST is a major limitation. To overcome this problem, rapid culture methods and molecular methods have been introduced. From a public health perspective, reducing the period between diagnosis and treatment initiation has direct benefits for both the patient and the community. For all patients of drug-resistant spinal TB, a complete Drug-O-Gram should be prepared which includes details of all drugs, their doses, and duration. Patients with confirmed multidrug-resistant TB strains should receive a regimen with at least five effective drugs, including pyrazinamide and one injectable. Patients with resistance to additional antitubercular drugs should receive individualized ATT as per their DST results.

  7. Assessing the impact of previous experience, and attitudes towards technology, on levels of engagement in a virtual reality based occupational therapy intervention for spinal cord injury rehabilitation

    LENUS (Irish Health Repository)

    McCaughey, Manus Dr.

    2007-01-01

    The aim of the current research project was to determine if there were significant differences between patients with higher or lower levels of experience with technology in terms of their level of engagement with virtual reality (VR) in occupational therapy, their future uptake of VR technology in therapy, and their attitudes towards technology. Patients’ experience of technology was also examined in relation to demographic characteristics such as age and education level.\\r\

  8. Kyphoplasty combined with intraoperative radiotherapy (Kypho-IORT). Alternative therapy for patients with oligometastatic spinal metastases; Kyphoplastie kombiniert mit intraoperativer Radiotherapie (Kypho-IORT). Therapiealternative fuer den oligometastasierten Patienten mit Wirbelsaeulenmetastasen

    Energy Technology Data Exchange (ETDEWEB)

    Bludau, F.; Obertacke, U. [Universitaetsklinikum Mannheim, Med. Fakultaet Mannheim der Universitaet Heidelberg, Orthopaedisch-Unfallchirurgisches Zentrum, Mannheim (Germany); Reis, T.; Schneider, F.; Clausen, S.; Wenz, F. [Universitaetsklinikum Mannheim, Med. Fakultaet Mannheim der Universitaet Heidelberg, Klinik fuer Strahlentherapie und Radioonkologie, Mannheim (Germany)

    2015-10-15

    Due to a more effective systemic therapy the survival of patients suffering from malignant tumors has been significantly improved but a longer life span is often associated with a higher incidence of osseous metastases. The majority of these metastases are localized in the spine causing pain, instability and neurological impairments. The interdisciplinary management of spinal metastases previously consisted of stabilization followed by fractionated external body radiation therapy. A reduction in procedural severity and morbidity as well as consideration of self-sufficiency and hospitalization time are important target parameters for these palliative patients. Kyphoplasty combined with intraoperative radiotherapy (Kypho-IORT) is one of several modern treatment options, which involves a minimally invasive procedure with local high-dose transpedicular irradiation of the spine with low-energy (50 kV) X-rays. Immediately following irradiation, stabilization of the spine is carried out using kyphoplasty via the same access route so that a single stage procedure with excellent pain reduction and good local tumor control can be achieved. This article presents clinical data for this procedure and the different fields of indications are critically reviewed and compared to other therapy options. Methodological improvements and options for further individualization of therapy are demonstrated. The Kypho-IORT procedure is a safe, feasible and beneficial modern treatment option for instant stabilization and local tumor control in patients with spinal metastases. More than 100 operations have been successfully performed so that the method can be deemed suitable for inclusion in the clinical routine. A phase II dose escalation study has now been completed and submitted for publication and a 2-arm non-inferiority trial (phase III study) for comparison with conventional irradiation is in progress. (orig.) [German] Durch verbesserte onkologische Therapie kommt es nicht nur zu einer

  9. Avaliação funcional e histológica da oxigenoterapia hiperbárica em ratos com lesão medular Functional and histologic evaluation of hyperbaric oxygen therapy in rats with spinal cord injury

    Directory of Open Access Journals (Sweden)

    Paulo Eduardo de Carvalho Galvão

    2011-01-01

    Full Text Available OBJETIVOS: Avaliar a eficácia da aplicação da oxigenoterapia hiperbárica em ratos Wistar, com lesão medular contusa produzida por equipamento computadorizado para impacto por queda de peso, NYU Impactor. MÉTODOS: Avaliaram-se 17 ratos machos com peso variando de 265 a 426 g; realizaram-se impactos com peso de 10 g de uma altura pré-determinada de 12,5 mm ao nível da décima vértebra torácica, após realização de laminectomia prévia. Os ratos foram divididos aleatoriamente em grupo controle e grupo oxigênio hiperbárico. Este último, submetido à tratamento com oxigenoterapia em câmara hiperbárica, durante uma hora diária por um período de 30 dias. A avaliação da recuperação locomotora foi realizada no 2º, 9º, 16º, 23º e 30º dia pós-operatório, avaliados através de escala funcional e o sítio de lesão submetido à exame anatomopatológico. RESULTADOS: Demonstrou-se melhora da recuperação locomotora nos ratos tratados com oxigênio hiperbárico nas fases iniciais de avaliação mas no final da avaliação não havia diferença estatisticamente significante entre ambos grupos. O exame anatomopatológico comprovou as alterações estruturais da medula espinal nos dois grupos. CONCLUSÃO: A lesão medular leve provocada nos ratos evoluiu de maneira diferente no grupo da oxigenoterapia hiperbárica comparativamente ao grupo controle, na fase inicial.OBJECTIVE: To evaluate the effectiveness of the application of hyperbaric oxygen therapy in Wistar rats with spinal cord contusion produced using computerized equipment to create impact by a falling weight, NYU Impactor. METHODS: We evaluated 17 male rats with weights ranging from 265 to 426 g; impacts were performed with a weight of 10 g from a pre-determined height of 12.5 mm, at the tenth thoracic vertebra, after completion of prior laminectomy. The rats were randomly divided into a control group and a group treated with hyperbaric oxygen. The latter, was treated with

  10. Remyelination of the injured spinal cord

    Science.gov (United States)

    Sasaki, Masanori; Li, Bingcang; Lankford, Karen L.; Radtke, Christine; Kocsis, Jeffery D.

    2008-01-01

    Contusive spinal cord injury (SCI) can result in necrosis of the spinal cord, but often long white matter tracts outside of the central necrotic core are demyelinated. One experimental strategy to improve functional outcome following SCI is to transplant myelin-forming cells to remyelinate these axons and improve conduction. This review focuses on transplantation studies using olfactory ensheathing cell (OEC) to improve functional outcome in experimental models of SCI and demyelination. The biology of the OEC, and recent experimental research and clinical studies using OECs as a potential cell therapy candidate are discussed. PMID:17618995

  11. Geometric control of manipulators

    International Nuclear Information System (INIS)

    Thiruarooran, C.

    1996-01-01

    Resolved motion control enables the end effector to be moved as a rigid body in space without having to work out manually the joint combinations needed. Since a rigid body in space has three independent translational and three independent rotational movements, a manipulator with at least six joints can be controlled in this way. Normally the manipulator has more than six joints providing an infinite number of ways of moving the tip in the desired direction and this redundancy can be exploited in a variety of ways. Resolved motion tests performed on a hydraulically operated heavy duty manipulator at the Dungeness nuclear power plant are described. The results have shown that manipulators with as many as ten joints can be controlled under resolved tip motion and the areas which are critical to the performance of this type of control have been identified. (UK)

  12. MATHEMATICAL MODEL MANIPULATOR ROBOTS

    Directory of Open Access Journals (Sweden)

    O. N. Krakhmalev

    2015-12-01

    Full Text Available A mathematical model to describe the dynamics of manipulator robots. Mathematical model are the implementation of the method based on the Lagrange equation and using the transformation matrices of elastic coordinates. Mathematical model make it possible to determine the elastic deviations of manipulator robots from programmed motion trajectories caused by elastic deformations in hinges, which are taken into account in directions of change of the corresponding generalized coordinates. Mathematical model is approximated and makes it possible to determine small elastic quasi-static deviations and elastic vibrations. The results of modeling the dynamics by model are compared to the example of a two-link manipulator system. The considered model can be used when performing investigations of the mathematical accuracy of the manipulator robots.

  13. Compliant Aerial Manipulators

    DEFF Research Database (Denmark)

    Bartelds, T.; Capra, A.; Hamaza, S.

    2016-01-01

    joints. The approach aims at limiting the influence of impacts on the controlled attitude dynamics in order to allow the aerial manipulator to remain stable during and after impact. The developed concept is intended to convert kinetic energy into potential energy, which is permanently stored into elastic...... elements by means of directional locking mechanisms. The proposed approach has been tested on a 2 d.o.f. manipulator mounted on a quadrotor UAV. The manipulation system has one active rotational d.o.f. compensating for pitch movements of the UAV and one passive linear joint which is in charge of absorbing...... the impact energy. The device has been used to validate the method through experiments, in comparison with a rigid manipulator. The results show that the proposed approach and the developed mechanical system achieve stable impact absorption without bouncing away from the interacting environment. Our work has...

  14. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Disabilities Photography by Rona Talcott Website by Mobile Marketing LLC Understanding Spinal Cord Injury About ... Your email address * This iframe contains the logic required to ...

  15. Spinal injury in sport

    Energy Technology Data Exchange (ETDEWEB)

    Barile, Antonio [Department of Radiology, University of L' Aquila, S. Salvatore Hospital, Via Vetoio, Coppito, 67100 L' Aquila (Italy)]. E-mail: antonio.barile@cc.univaq.it; Limbucci, Nicola [Department of Radiology, University of L' Aquila, S. Salvatore Hospital, Via Vetoio, Coppito, 67100 L' Aquila (Italy); Splendiani, Alessandra [Department of Radiology, University of L' Aquila, S. Salvatore Hospital, Via Vetoio, Coppito, 67100 L' Aquila (Italy); Gallucci, Massimo [Department of Radiology, University of L' Aquila, S. Salvatore Hospital, Via Vetoio, Coppito, 67100 L' Aquila (Italy); Masciocchi, Carlo [Department of Radiology, University of L' Aquila, S. Salvatore Hospital, Via Vetoio, Coppito, 67100 L' Aquila (Italy)

    2007-04-15

    Spinal injuries are very common among professional or amateur athletes. Spinal sport lesions can be classified in overuse and acute injuries. Overuse injuries can be found after years of repetitive spinal load during sport activity; however specific overuse injuries can also be found in adolescents. Acute traumas are common in contact sports. Most of the acute injuries are minor and self-healing, but severe and catastrophic events are possible. The aim of this article is to review the wide spectrum of spinal injuries related to sport activity, with special regard to imaging finding.

  16. Spinal CT scan, 1

    International Nuclear Information System (INIS)

    Nakagawa, Hiroshi

    1982-01-01

    Methods of CT of the cervical and thoracic spines were explained, and normal CT pictures of them were described. Spinal CT was evaluated in comparison with other methods in various spinal diseases. Plain CT revealed stenosis due to spondylosis or ossification of posterior longitudinal ligament and hernia of intervertebral disc. CT took an important role in the diagnosis of spinal cord tumors with calcification and destruction of the bone. CT scan in combination with other methods was also useful for the diagnosis of spinal injuries, congenital anomalies and infections. (Ueda, J.)

  17. MULTIPLE SPINAL CANAL MENINGIOMAS

    Directory of Open Access Journals (Sweden)

    Nandigama Pratap Kumar

    2016-10-01

    Full Text Available BACKGROUND Meningiomas of the spinal canal are common tumours with the incidence of 25 percent of all spinal cord tumours. But multiple spinal canal meningiomas are rare in compare to solitary lesions and account for 2 to 3.5% of all spinal meningiomas. Most of the reported cases are both intra cranial and spinal. Exclusive involvement of the spinal canal by multiple meningiomas are very rare. We could find only sixteen cases in the literature to the best of our knowledge. Exclusive multiple spinal canal meningiomas occurring in the first two decades of life are seldom reported in the literature. We are presenting a case of multiple spinal canal meningiomas in a young patient of 17 years, who was earlier operated for single lesion. We analysed the literature, with illustration of our case. MATERIALS AND METHODS In September 2016, we performed a literature search for multiple spinal canal meningiomas involving exclusively the spinal canal with no limitation for language and publication date. The search was conducted through http://pubmed.com, a wellknown worldwide internet medical address. To the best of our knowledge, we could find only sixteen cases of multiple meningiomas exclusively confined to the spinal canal. Exclusive multiple spinal canal meningiomas occurring in the first two decades of life are seldom reported in the literature. We are presenting a case of multiple spinal canal meningiomas in a young patient of 17 years, who was earlier operated for solitary intradural extra medullary spinal canal meningioma at D4-D6 level, again presented with spastic quadriparesis of two years duration and MRI whole spine demonstrated multiple intradural extra medullary lesions, which were excised completely and the histopathological diagnosis was transitional meningioma. RESULTS Patient recovered from his weakness and sensory symptoms gradually and bladder and bowel symptoms improved gradually over a period of two to three weeks. CONCLUSION Multiple

  18. Spinal injury in sport

    International Nuclear Information System (INIS)

    Barile, Antonio; Limbucci, Nicola; Splendiani, Alessandra; Gallucci, Massimo; Masciocchi, Carlo

    2007-01-01

    Spinal injuries are very common among professional or amateur athletes. Spinal sport lesions can be classified in overuse and acute injuries. Overuse injuries can be found after years of repetitive spinal load during sport activity; however specific overuse injuries can also be found in adolescents. Acute traumas are common in contact sports. Most of the acute injuries are minor and self-healing, but severe and catastrophic events are possible. The aim of this article is to review the wide spectrum of spinal injuries related to sport activity, with special regard to imaging finding

  19. Spinal trauma. An imaging approach

    Energy Technology Data Exchange (ETDEWEB)

    Cassar-Pullicino, V.N. [The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire (United Kingdom). Dept. of Radiology; Imhof, H. [University and General Hospital Vienna (Austria). Dept. of Radiodiagnostics

    2006-07-01

    The diagnosis of trauma to the spine - where the slightest oversight may have catastrophic results - requires a thorough grasp of the spectrum of resultant pathology as well as the imaging modalities used in making an accurate diagnosis. In Spinal Trauma, the internationally renowned team of experts provides a comprehensive, cutting-edge exposition of the current vital role of imaging in the diagnosis and treatment of injuries to the axial skeleton. Beginning with a valuable clinical perspective of spinal trauma, the book offers the reader a unique overview of the biomechanics underlying the pathology of cervical trauma. Acute trauma topics include: - Optimization of imaging modalities - Malalignment - signs and significance - Vertebral fractures - detection and implications - Classification of thoraco-lumbar fractures - rationale and relevance - Neurovascular injury. Distilling decades of clinical and teaching expertise, the contributors further discuss the current role of imaging in special focus topics, which include: - The pediatric spine - Sports injuries - The rigid spine - Trauma in the elderly - Vertebral collapse, benign and malignant - Spinal trauma therapy - Vertebral fractures and osteoporosis - Neuropathic spine. All throughout the book, the focus is on understanding the injury, and its implications and complications, through 'an imaging approach'. Lavishly illustrated with hundreds of superb MR images and CT scans, and clear full-color drawings, the authors conclude with a look into the future, defining clinical trends and research directions. Spinal Trauma - with its broad scope, practical imaging approach, and current focus - is designed to enhance confidence and accuracy, making it essential reading for clinicians and radiologists at all levels. (orig.)

  20. Manipulating Strings in Python

    Directory of Open Access Journals (Sweden)

    William J. Turkel

    2012-07-01

    Full Text Available This lesson is a brief introduction to string manipulation techniques in Python. Knowing how to manipulate strings plays a crucial role in most text processing tasks. If you’d like to experiment with the following lessons, you can write and execute short programs as we’ve been doing, or you can open up a Python shell / Terminal to try them out on the command line.

  1. Adverse events associated with the use of cervical manipulation or mobilization and patient characteristics : a systematic review

    NARCIS (Netherlands)

    Kranenburg, Rik; Schmitt, M.A.; Luijckx, Gert Jan; Puentedura, E.J.; van der Schans, Cees

    2016-01-01

    Cervical spinal manipulation (CSM) and cervical mobilization are frequently used in patients with neck pain and headache. Pre-manipulative cervical instability and arterial integrity tests appear to be unreliable in identifying patients at risk at risk for adverse events. It would be valuable if

  2. Adverse events associated with the use of cervical spine manipulation or mobilization and patient characteristics : A systematic review

    NARCIS (Netherlands)

    Kranenburg, H. A.; Schmitt, M. A.; Puentedura, E. J.; Luijckx, G. J.; van der Schans, C. P.

    Cervical spinal manipulation (CSM) and cervical mobilization are frequently used in patients with neck pain and headache. Pre-manipulative cervical instability and arterial integrity tests appear to be unreliable in identifying patients at risk for adverse events. It would be valuable if patients at

  3. Safety and efficacy of at-home robotic locomotion therapy in individuals with chronic incomplete spinal cord injury: a prospective, pre-post intervention, proof-of-concept study.

    Directory of Open Access Journals (Sweden)

    Rüdiger Rupp

    Full Text Available The compact Motorized orthosis for home rehabilitation of Gait (MoreGait was developed for continuation of locomotion training at home. MoreGait generates afferent stimuli of walking with the user in a semi-supine position and provides feedback about deviations from the reference walking pattern.Prospective, pre-post intervention, proof-of-concept study to test the feasibility of an unsupervised home-based application of five MoreGait prototypes in subjects with incomplete spinal cord injury (iSCI.Twenty-five (5 tetraplegia, 20 paraplegia participants with chronic (mean time since injury: 5.8 ± 5.4 (standard deviation, SD years sensorimotor iSCI (7 ASIA Impairment Scale (AIS C, 18 AIS D; Walking Index for Spinal Cord Injury (WISCI II: Interquartile range 9 to 16 completed the training (45 minutes / day, at least 4 days / week, 8 weeks. Baseline status was documented 4 and 2 weeks before and at training onset. Training effects were assessed after 4 and 8 weeks of therapy.After therapy, 9 of 25 study participants improved with respect to the dependency on walking aids assessed by the WISCI II. For all individuals, the short-distance walking velocity measured by the 10-Meter Walk Test showed significant improvements compared to baseline (100% for both self-selected (Mean 139.4% ± 35.5% (SD and maximum (Mean 143.1% ± 40.6% (SD speed conditions as well as the endurance estimated with the six-minute walk test (Mean 166.6% ± 72.1% (SD. One device-related adverse event (pressure sore on the big toe occurred in over 800 training sessions.Home-based robotic locomotion training with MoreGait is feasible and safe. The magnitude of functional improvements achieved by MoreGait in individuals with iSCI is well within the range of complex locomotion robots used in hospitals. Thus, unsupervised MoreGait training potentially represents an option to prolong effective training aiming at recovery of locomotor function beyond in-patient rehabilitation

  4. Rehabilitation effect of exercise with soft tissue manipulation in ...

    African Journals Online (AJOL)

    Rehabilitation effect of exercise with soft tissue manipulation in patients with lumbar muscle strain. H Li, H Zhang, S Liu, Y Wang, D Gai, Q Lu, H Gan, Y Shi, W Qi. Abstract. Objective: To study the rehabilitation effect of exercise with soft tissue manipulation therapy for patients with lumbar muscle strain. Methods: Patients with ...

  5. Spinal cord regeneration: moving tentatively towards new perspectives.

    Science.gov (United States)

    Jones, D G; Anderson, E R; Galvin, K A

    2003-01-01

    The failure of the adult human spinal cord to regenerate following injury is not absolute, but appears to be amenable to therapeutic manipulation. Recent work has shown that the provision of a growth permissive environment by the neutralization of inhibitory influences, or the grafting of fetal tissue, peripheral nerve, Schwann cells, or olfactory ensheathing cells can enhance regeneration in animal models of spinal cord injury. Stem cells are gaining ever-increasing favour as a treatment option for spinal cord injury. The potential of neural stem cells, embryonic stem cells, and bone marrow stromal cells is discussed. Additional treatment options such as pharmacological interventions, functional electrical stimulation and physiotherapy approaches are also explored. Basic science insights are used as a foundation for a discussion of a variety of clinical perspectives including repair of the chronically injured spinal cord, animal models of human spinal cord injuries and clinical trials. A more holistic approach towards spinal cord injury is suggested, one where a hierarchy of needs is recognised and quality of life is paramount. Finally, this review cautions against overly grandiose claims of an imminent miracle cure for human spinal cord injury.

  6. Development and characterization of a PHB-HV-based 3D scaffold for a tissue engineering and cell-therapy combinatorial approach for spinal cord injury regeneration.

    Science.gov (United States)

    Ribeiro-Samy, Silvina; Silva, Nuno A; Correlo, Vitor M; Fraga, Joana S; Pinto, Luísa; Teixeira-Castro, Andreia; Leite-Almeida, Hugo; Almeida, Armando; Gimble, Jeffrey M; Sousa, Nuno; Salgado, António J; Reis, Rui L

    2013-11-01

    Spinal cord injury (SCI) leads to devastating neurological deficits. Several tissue engineering (TE)-based approaches have been investigated for repairing this condition. Poly (3-hydroxybutyrate-co-3-hydroxyvalerate) (PHB-HV) is found to be particularly attractive for TE applications due to its properties, such as biodegradability, biocompatibility, thermoplasticity and piezoelectricity. Hence, this report addresses the development and characterization of PHB-HV-based 3D scaffolds, produced by freeze-drying, aimed to SCI treatment. The obtained scaffolds reveal an anisotropic morphology with a fully interconnected network of pores. In vitro studies demonstrate a lack of cytotoxic effect of PHB-HV scaffolds. Direct contact assays also reveal their ability to support the culture of CNS-derived cells and mesenchymal-like stem cells from different sources. Finally, histocompatibility studies show that PHB-HV scaffolds are well tolerated by the host tissue, and do not negatively impact the left hindlimb locomotor function recovery. Therefore results herein presented suggest that PHB-HV scaffolds may be suitable for SCI treatment. © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  7. Local Setup Reproducibility of the Spinal Column When Using Intensity-Modulated Radiation Therapy for Craniospinal Irradiation With Patient in Supine Position

    International Nuclear Information System (INIS)

    Stoiber, Eva Maria; Giske, Kristina; Schubert, Kai; Sterzing, Florian; Habl, Gregor; Uhl, Matthias; Herfarth, Klaus; Bendl, Rolf; Debus, Jürgen

    2011-01-01

    Purpose: To evaluate local positioning errors of the lumbar spine during fractionated intensity-modulated radiotherapy of patients treated with craniospinal irradiation and to assess the impact of rotational error correction on these uncertainties for one patient setup correction strategy. Methods and Materials: 8 patients (6 adults, 2 children) treated with helical tomotherapy for craniospinal irradiation were retrospectively chosen for this analysis. Patients were immobilized with a deep-drawn Aquaplast head mask. Additionally to daily megavoltage control computed tomography scans of the skull, once-a-week positioning of the lumbar spine was assessed. Therefore, patient setup was corrected by a target point correction, derived from a registration of the patient's skull. The residual positioning variations of the lumbar spine were evaluated applying a rigid-registration algorithm. The impact of different rotational error corrections was simulated. Results: After target point correction, residual local positioning errors of the lumbar spine varied considerably. Craniocaudal axis rotational error correction did not improve or deteriorate these translational errors, whereas simulation of a rotational error correction of the right–left and anterior–posterior axis increased these errors by a factor of 2 to 3. Conclusion: The patient fixation used allows for deformations between the patient's skull and spine. Therefore, for the setup correction strategy evaluated in this study, generous margins for the lumbar spinal target volume are needed to prevent a local geographic miss. With any applied correction strategy, it needs to be evaluated whether or not a rotational error correction is beneficial.

  8. Regional interdependence and manual therapy directed at the thoracic spine.

    Science.gov (United States)

    McDevitt, Amy; Young, Jodi; Mintken, Paul; Cleland, Josh

    2015-07-01

    Thoracic spine manipulation is commonly used by physical therapists for the management of patients with upper quarter pain syndromes. The theoretical construct for using thoracic manipulation for upper quarter conditions is a mainstay of a regional interdependence (RI) approach. The RI concept is likely much more complex and is perhaps driven by a neurophysiological response including those related to peripheral, spinal cord and supraspinal mechanisms. Recent evidence suggests that thoracic spine manipulation results in neurophysiological changes, which may lead to improved pain and outcomes in individuals with musculoskeletal disorders. The intent of this narrative review is to describe the research supporting the RI concept and its application to the treatment of individuals with neck and/or shoulder pain. Treatment utilizing both thrust and non-thrust thoracic manipulation has been shown to result in improvements in pain, range of motion and disability in patients with upper quarter conditions. Research has yet to determine optimal dosage, techniques or patient populations to which the RI approach should be applied; however, emerging evidence supporting a neurophysiological effect for thoracic spine manipulation may negate the need to fully answer this question. Certainly, there is a need for further research examining both the clinical efficacy and effectiveness of manual therapy interventions utilized in the RI model as well as the neurophysiological effects resulting from this intervention.

  9. Spinal epidural empyema in two dogs

    International Nuclear Information System (INIS)

    Dewey, C.W.; Kortz, G.D.; Bailey, C.S.

    1998-01-01

    Extensive, diffuse, epidural spinal cord compression was visualized myelographically in two dogs presented for rapid development of nonambulatory tetraparesis and paraplegia, respectively. Purulent fluid containing bacterial organisms was aspirated percutaneously under fluoroscopic guidance from the epidural space of each dog. One dog responded poorly to aggressive medical therapy, which included installation of an epidural lavage and drainage system. Both dogs were euthanized due to the severe nature of their disorder and the poor prognosis. Spinal epidural empyema (i.e., abscess) is a rare condition in humans and has not been reported previously in the veterinary literature. Spinal epidural empyema should be considered as a differential diagnosis in dogs presenting with painful myelopathies, especially when accompanied by fever

  10. Biomarkers in spinal cord compression Ethics and perspectives

    Directory of Open Access Journals (Sweden)

    Iencean A.St.

    2016-09-01

    Full Text Available The phosphorylated form of the high-molecular-weight neurofilament subunit NF-H (pNF-H in serum or in cerebro-spinal fluid (CSF is a specific lesional biomarker for spinal cord injury. The lesional biomarkers and the reaction biomarkers are both presented after several hours post-injury. The specific predictive patterns of lesional biomarkers could be used to aid clinicians with making a diagnosis and establishing a prognosis, and evaluating therapeutic interventions. Diagnosis, prognosis, and treatment guidance based on biomarker used as a predictive indicator can determine ethical difficulties by differentiated therapies in patients with spinal cord compression. At this point based on studies until today we cannot take a decision based on biomarker limiting the treatment of neurological recovery in patients with complete spinal cord injury because we do not know the complexity of the biological response to spinal cord compression.

  11. Diagnosis and treatment of spinal tuberculosis after liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Peng-Cheng Gu; Rong-Huan Wu; Xiang-Jin Lin

    2009-01-01

    BACKGROUND: Spinal tuberculosis is a common disease in orthopedic clinical practice; however, it is seldom reported after organ transplantation. The aim of this study was to investigate the diagnosis and treatment of spinal tuberculosis after organ transplantation. METHOD: Two cases were diagnosed as spinal tuberculosis after liver transplantation and were treated with socarboxazide, rifampicin, streptomycin and ethambutol for more than one year. RESULTS: After treatment with anti-tuberculosis drugs for several months, the symptoms of both patients clearly improved. Back pain disappeared, and erythrocyte sedimentation and body temperature returned to normal. CONCLUSIONS: We should highly suspect spinal tuberculosis if notalgia and night sweats are present after organ transplantation. Anti-tuberculosis therapy is an effective treatment for spinal tuberculosis after organ transplantation.

  12. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Cord Injury Allen Heinemann, PhD How Peer Counseling Works Julie Gassaway, MS, RN Pediatric Injuries Pediatric Spinal ... injury? play_arrow How does the spinal cord work? play_arrow Why is the level of a ...

  13. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Spinal Cord Injury Guy W. Fried, MD Substance Abuse and Spinal Cord Injury Allen Heinemann, PhD How ... arrow Why are high-dose steroids often used right after an injury? play_arrow What is meant ...

  14. Lumbar spinal stenosis

    DEFF Research Database (Denmark)

    Lønne, Greger; Fritzell, Peter; Hägg, Olle

    2018-01-01

    BACKGROUND: Decompression surgery for lumbar spinal stenosis (LSS) is the most common spinal procedure in the elderly. To avoid persisting low back pain, adding arthrodesis has been recommended, especially if there is a coexisting degenerative spondylolisthesis. However, this strategy remains con...

  15. Chronic spinal subdural hematoma

    International Nuclear Information System (INIS)

    Hagen, T.; Lensch, T.

    2008-01-01

    Compared with spinal epidural hematomas, spinal subdural hematomas are rare; chronic forms are even more uncommon. These hematomas are associated not only with lumbar puncture and spinal trauma, but also with coagulopathies, vascular malformations and tumors. Compression of the spinal cord and the cauda equina means that the patients develop increasing back or radicular pain, followed by paraparesis and bladder and bowel paralysis, so that in most cases surgical decompression is carried out. On magnetic resonance imaging these hematomas present as thoracic or lumbar subdural masses, their signal intensity varying with the age of the hematoma. We report the clinical course and the findings revealed by imaging that led to the diagnosis in three cases of chronic spinal subdural hematoma. (orig.) [de

  16. Local Setup Reproducibility of the Spinal Column When Using Intensity-Modulated Radiation Therapy for Craniospinal Irradiation With Patient in Supine Position

    Energy Technology Data Exchange (ETDEWEB)

    Stoiber, Eva Maria, E-mail: eva.stoiber@med.uni-heidelberg.de [Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg (Germany); Department of Medical Physics, German Cancer Research Center, Heidelberg (Germany); Giske, Kristina [Department of Medical Physics, German Cancer Research Center, Heidelberg (Germany); Schubert, Kai; Sterzing, Florian; Habl, Gregor; Uhl, Matthias; Herfarth, Klaus [Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg (Germany); Bendl, Rolf [Department of Medical Physics, German Cancer Research Center, Heidelberg (Germany); Medical Informatics, Heilbronn University, Heilbronn (Germany); Debus, Juergen [Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg (Germany)

    2011-12-01

    Purpose: To evaluate local positioning errors of the lumbar spine during fractionated intensity-modulated radiotherapy of patients treated with craniospinal irradiation and to assess the impact of rotational error correction on these uncertainties for one patient setup correction strategy. Methods and Materials: 8 patients (6 adults, 2 children) treated with helical tomotherapy for craniospinal irradiation were retrospectively chosen for this analysis. Patients were immobilized with a deep-drawn Aquaplast head mask. Additionally to daily megavoltage control computed tomography scans of the skull, once-a-week positioning of the lumbar spine was assessed. Therefore, patient setup was corrected by a target point correction, derived from a registration of the patient's skull. The residual positioning variations of the lumbar spine were evaluated applying a rigid-registration algorithm. The impact of different rotational error corrections was simulated. Results: After target point correction, residual local positioning errors of the lumbar spine varied considerably. Craniocaudal axis rotational error correction did not improve or deteriorate these translational errors, whereas simulation of a rotational error correction of the right-left and anterior-posterior axis increased these errors by a factor of 2 to 3. Conclusion: The patient fixation used allows for deformations between the patient's skull and spine. Therefore, for the setup correction strategy evaluated in this study, generous margins for the lumbar spinal target volume are needed to prevent a local geographic miss. With any applied correction strategy, it needs to be evaluated whether or not a rotational error correction is beneficial.

  17. Radiation tolerance of the cervical spinal cord

    International Nuclear Information System (INIS)

    McCunniff, A.J.; Liang, M.J.

    1989-01-01

    The incidence of permanent injury to the spinal cord as a complication of radiation therapy generally correlates positively with total radiation dosage. However, several reports in the literature have indicated that fraction size is also an important factor in the development or nondevelopment of late injuries in normal tissue. To determine the effect of fraction size on the incidence of radiation-induced spinal cord injuries, we reviewed 144 cases of head and neck cancer treated at our institution between 1971 and 1980 with radiation greater than 5600 cGy to a portion of the cervical spinal cord. Most of these patients received greater than or equal to 6000 cGy, with fraction sizes ranging from 133 cGy to 200 cGy. Fifty-three of the 144 patients have been followed up for 2 years or more. Nearly half of these (26 patients) received greater than 6000 cGy with fraction sizes of 133 cGy to 180 cGy. Only 1 of the 53 (1.9%) has sustained permanent spinal cord injury; 20 months after completion of radiation treatments he developed Brown-Sequard syndrome. Our experience suggests that radiation injuries to the spinal cord correlate not only with total radiation dosage, but also with fraction size; low fraction sizes appear to decrease the incidence of such injuries

  18. Radiation effects in brain and spinal cord

    International Nuclear Information System (INIS)

    Franke, H.D.; Lierse, W.

    1978-01-01

    Radiation sensitivity of both the brain and spinal cord in prenatal and postnatal stages, in infancy and adult age is represented also in consideration of a combined treatment with methotrexate. In adults, application of important doses of high-energy radiation increases the risk of injurious effects to the central nervous system. If the spinal cord is involved, more than 60% of the radiolesions have a progredient course ending with death. The pathogenesis and disposing factors are referred to, and the incidence of radiation necrosis with regard to age and sex, the degrees of injury and their frequence within different ranges of dosage are analyzed on the basis of data from universal literature. An examination of 'tolerance doses' for the spinal cord is made by means of Strandquist-diagrams and of the Ellis-formula. The slopes of regression lines are reported for various 'degrees of response' in skin, brain and spinal cord following radiation therapy. In the Strandquist-diagram, slopes of regression lines are dependent on the 'degree of response', flattening if skin and spinal cord are affected by radiation in the same degree, necroses having the same slope for both the organs. (orig./MG) [de

  19. Synaptic defects in the spinal and neuromuscular circuitry in a mouse model of spinal muscular atrophy.

    Directory of Open Access Journals (Sweden)

    Karen K Y Ling

    2010-11-01

    Full Text Available Spinal muscular atrophy (SMA is a major genetic cause of death in childhood characterized by marked muscle weakness. To investigate mechanisms underlying motor impairment in SMA, we examined the spinal and neuromuscular circuitry governing hindlimb ambulatory behavior in SMA model mice (SMNΔ7. In the neuromuscular circuitry, we found that nearly all neuromuscular junctions (NMJs in hindlimb muscles of SMNΔ7 mice remained fully innervated at the disease end stage and were capable of eliciting muscle contraction, despite a modest reduction in quantal content. In the spinal circuitry, we observed a ∼28% loss of synapses onto spinal motoneurons in the lateral column of lumbar segments 3-5, and a significant reduction in proprioceptive sensory neurons, which may contribute to the 50% reduction in vesicular glutamate transporter 1(VGLUT1-positive synapses onto SMNΔ7 motoneurons. In addition, there was an increase in the association of activated microglia with SMNΔ7 motoneurons. Together, our results present a novel concept that synaptic defects occur at multiple levels of the spinal and neuromuscular circuitry in SMNΔ7 mice, and that proprioceptive spinal synapses could be a potential target for SMA therapy.

  20. Atomic and molecular manipulation

    CERN Document Server

    Mayne, Andrew J

    2011-01-01

    Work with individual atoms and molecules aims to demonstrate that miniaturized electronic, optical, magnetic, and mechanical devices can operate ultimately even at the level of a single atom or molecule. As such, atomic and molecular manipulation has played an emblematic role in the development of the field of nanoscience. New methods based on the use of the scanning tunnelling microscope (STM) have been developed to characterize and manipulate all the degrees of freedom of individual atoms and molecules with an unprecedented precision. In the meantime, new concepts have emerged to design molecules and substrates having specific optical, mechanical and electronic functions, thus opening the way to the fabrication of real nano-machines. Manipulation of individual atoms and molecules has also opened up completely new areas of research and knowledge, raising fundamental questions of "Optics at the atomic scale", "Mechanics at the atomic scale", Electronics at the atomic scale", "Quantum physics at the atomic sca...

  1. Balanced articulated manipulator

    International Nuclear Information System (INIS)

    Francois, Daniel; Germond, J.-C.; Marchal, Paul; Vertut, Jean.

    1976-01-01

    The description is given of a manipulator of the type comprising a master arm and a slave arm, capable of working in a containment restricted by a wall fitted with an aperture to introduce the slave arm into the containment. According to the invention this manipulator is permanently balanced irrespective of its distortions when it is secured to the wall of the containment in which it is desired to work. The entire manipulator is also balanced when being set up and when moved outside the containment, in relation to a supporting axle. This result is achieved in a simplified manner by giving homothetic shapes to the various component parts of the slave and master arms, the master arm having at least one balancing weight [fr

  2. Stainless steel decontamination manipulators

    International Nuclear Information System (INIS)

    Sullivan, R.J.

    1986-01-01

    Three, large-volume coverage manipulator systems were designed and built for the Defense Water Processing Facility at the Savannah River Laboratory. These stainless steel systems will be used for high-pressure spray decontamination of waste containers and large process equipment modules. Each system has a manipulator arm, folding boom, and vertical drive and guide structure. Handling capacity is 45 kg, horizontal reach is 4.6 m with a 180-deg swing motion, and the vertical travel is 6 m. The system is remotely removable and replaceable in modules using an overhead crane and an impact wrench. The manipulator arm has seven motions: Shoulder rotation and pivot, elbow pivot, wrist pivot and rotation, and grip open-close. All motions are variable speed and are slip-clutch protected to prevent overloading from external forces (collisions)

  3. Data manipulation with R

    CERN Document Server

    Abedin, Jaynal

    2014-01-01

    This book is a step-by step, example-oriented tutorial that will show both intermediate and advanced users how data manipulation is facilitated smoothly using R.This book is aimed at intermediate to advanced level users of R who want to perform data manipulation with R, and those who want to clean and aggregate data effectively. Readers are expected to have at least an introductory knowledge of R and some basic administration work in R, such as installing packages and calling them when required.

  4. Cost-effectiveness evaluation of an RCT in rehabilitation after lumbar spinal fusion: a low-cost, behavioural approach is cost-effective over individual exercise therapy

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Laurberg, Ida; Christensen, Finn B

    2008-01-01

    Recently, Christensen et al. reported the clinical effects of a low-cost rehabilitation program equally efficient to a relatively intensive program of individual, physiotherapist-guided exercise therapy. Yet, the low-cost approach is not fully supported as an optimal strategy until a full......-scale economic evaluation, including extra-hospital effects such as service utilization in the primary health care sector and return-to-work, is conducted. The objective of this study was to conduct such evaluation i.e. investigate the cost-effectiveness of (1) a low-cost rehabilitation regimen...... with a behavioural element and (2) a regimen of individual exercise therapy, both in comparison with usual practice, from a health economic, societal perspective. Study design was a cost-effectiveness evaluation of an RCT with a 2-year follow-up. Ninety patients having had posterolateral or circumferential fusion...

  5. Nuclear magnetic imaging for MTRA. Spinal canal and spinal cord

    International Nuclear Information System (INIS)

    Fritzsch, Dominik; Hoffmann, Karl-Titus

    2011-01-01

    The booklet covers the following topics: (1) Clinical indications for NMR imaging of spinal cord and spinal canal; (2) Methodic requirements: magnets and coils, image processing, contrast media: (3) Examination technology: examination conditions, sequences, examination protocols; (4) Disease pattern and indications: diseases of the myelin, the spinal nerves and the spinal canal (infections, tumors, injuries, ischemia and bleedings, malformations); diseases of the spinal cord and the intervertebral disks (degenerative changes, infections, injuries, tumors, malformations).

  6. CT-guided ozone/steroid therapy for the treatment of degenerative spinal disease - effect of age, gender, disc pathology and multi-segmental changes

    Energy Technology Data Exchange (ETDEWEB)

    Oder, Bernhard; Loewe, Maria; Reisegger, Michael; Thurnher, Siegfried A. [Hospital Brothers of St. John of God, Department of Radiology and Nuclear Medicine, Vienna (Austria); Lang, Wilfried [Hospital Brothers of St. John of God, Department of Neurology, Vienna (Austria); Ilias, Wilfried [Hospital Brothers of St. John of God, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Vienna (Austria)

    2008-09-15

    Oxygen-ozone nucleolysis (ONL) is a new, minimally invasive procedure for the treatment of discogenic low back pain with or without radicular symptoms. The aim of the present study was to determine associations between the morphology of the basic disease, patient-specific factors and the outcome of the treatment. Six hundred and twelve patients not responding to conservative therapy were divided into five groups (disc bulging, disc herniation, postoperative patients, osteochondrosis, others) and subjected to nucleolysis with ozone and to periradicular infiltration with steroids and local anaesthesia. The success of treatment was assessed by means of a visual analog pain scale (VAS) and the Oswestry Disability Index (ODI). A significant reduction in the VAS was registered after 2 and 6 months (from 8.6 to 5.4 and 6.0; p<0.001) in all patient groups; an excellent therapy response (VAS below 3.0) was achieved by about a third of the patients. A significant improvement in ODI was registered in all patients (46 to 31; p<0.001), most pronounced in the herniation group (25.5, p=0.015). Patients below 50 years had significantly better values in the VAS and ODI score 6 months after treatment. Final VAS and ODI scores for patients with a single diseased segment were 4.2 and 28.0, in two affected segments 6.5 and 32 and in three segments 6.7 and 38.5 (p<0.001 and p=0.051). ONL with periradicular steroid therapy might exert a functional and sustained analgesic effect in patients with degenerative changes in the lumbar spine not responding to conservative therapy and was most effective below 50 years with disc herniation in one segment. (orig.)

  7. CT-guided ozone/steroid therapy for the treatment of degenerative spinal disease - effect of age, gender, disc pathology and multi-segmental changes

    International Nuclear Information System (INIS)

    Oder, Bernhard; Loewe, Maria; Reisegger, Michael; Thurnher, Siegfried A.; Lang, Wilfried; Ilias, Wilfried

    2008-01-01

    Oxygen-ozone nucleolysis (ONL) is a new, minimally invasive procedure for the treatment of discogenic low back pain with or without radicular symptoms. The aim of the present study was to determine associations between the morphology of the basic disease, patient-specific factors and the outcome of the treatment. Six hundred and twelve patients not responding to conservative therapy were divided into five groups (disc bulging, disc herniation, postoperative patients, osteochondrosis, others) and subjected to nucleolysis with ozone and to periradicular infiltration with steroids and local anaesthesia. The success of treatment was assessed by means of a visual analog pain scale (VAS) and the Oswestry Disability Index (ODI). A significant reduction in the VAS was registered after 2 and 6 months (from 8.6 to 5.4 and 6.0; p<0.001) in all patient groups; an excellent therapy response (VAS below 3.0) was achieved by about a third of the patients. A significant improvement in ODI was registered in all patients (46 to 31; p<0.001), most pronounced in the herniation group (25.5, p=0.015). Patients below 50 years had significantly better values in the VAS and ODI score 6 months after treatment. Final VAS and ODI scores for patients with a single diseased segment were 4.2 and 28.0, in two affected segments 6.5 and 32 and in three segments 6.7 and 38.5 (p<0.001 and p=0.051). ONL with periradicular steroid therapy might exert a functional and sustained analgesic effect in patients with degenerative changes in the lumbar spine not responding to conservative therapy and was most effective below 50 years with disc herniation in one segment. (orig.)

  8. MANIPULATING CONSUMERS THROUGH ADVERTISING

    Directory of Open Access Journals (Sweden)

    Nicoleta -Andreea Neacşu

    2012-12-01

    Full Text Available Marketing communication has evolved steadily in the direction of increasing complexity and increasing volume of funds needed to run their own actions. More than ever, consumers are exposed to an overwhelming variety of sources and communication tehniques, the information received being numerous, diverse and polyvalent. The desire to make more efficient the marketing communication activity urges the broadcasters to encode messages, to use effective means of propagation in order to obtain a high degree of control on receptors and to influence the consumption attitudes. Between the means used for this purpose, manipulation tehniques are well known. This paper highlights the main conclusions drawn as a result of a quantitative marketing research on the adult population from Braşov in order to identify the attitudes and opinions of consumers from Braşov regarding the manipulation techniques used by commercial practices and advertising.The results of the research have shown that 82% of the respondents buy products in promotional offers, and 18% choose not to buy these products and 61% of the respondents consider that they have not been manipulated not even once, while only 39% believe that they have been manipulated at least once through advertising or commercial practices. Advertisements on TV have a strong influence on consumers, 81% of the respondents considering that at least once they have bought a product because of a TV commercial.

  9. Manipulating the Gradient

    Science.gov (United States)

    Gaze, Eric C.

    2005-01-01

    We introduce a cooperative learning, group lab for a Calculus III course to facilitate comprehension of the gradient vector and directional derivative concepts. The lab is a hands-on experience allowing students to manipulate a tangent plane and empirically measure the effect of partial derivatives on the direction of optimal ascent. (Contains 7…

  10. Microrobots to Manipulate Cells

    DEFF Research Database (Denmark)

    Glückstad, Jesper

    At DTU Fotonik we developed and harnessed the new and emerging research area of so-called Light Robotics including the 3D-printed micro-tools coined Wave-guided Optical Waveguides that can be real-time laser-manipulated in a 3D-volume with six-degrees-of-freedom. To be exploring the full potentia...

  11. Automated visual attention manipulation

    NARCIS (Netherlands)

    Bosse, T.; Lambalgen, R. van; Maanen, P.P. van; Treur, J.

    2009-01-01

    In this paper a system for visual attention manipulation is introduced and formally described. This system is part of the design of a software agent that supports naval crew in her task to compile a tactical picture of the situation in the field. A case study is described in hich the system is used

  12. Data manipulation with R

    CERN Document Server

    Abedin, Jaynal

    2015-01-01

    This book is for all those who wish to learn about data manipulation from scratch and excel at aggregating data effectively. It is expected that you have basic knowledge of R and have previously done some basic administration work with R.

  13. The TFTR maintenance manipulator

    International Nuclear Information System (INIS)

    Kungl, D.; Loesser, D.; Heitzenroeder, P.; Cerdan, G.

    1989-01-01

    TFTR plans to begin D-T experiments in mid 1990. The D-T experimental program will produce approximately one hundred shots, with a neutron generation rate of 10 19 neutrons per shot. This will result in high levels of activation in TFTR, especially in the vacuum vessel. The primary purpose of the Maintenance Manipulator is to provide a means of remotely performing certain defined maintenance and inspection tasks inside the vacuum torus so as to minimize personnel exposure to radiation. The manipulator consists of a six-link folding boom connected to a fixed boom on a movable carriage. The entire manipulator is housed in a vacuum antechamber connected to the vacuum torus, through a port formerly used for a vacuum pumping duct. The configuration extends 180 0 in either direction to provide complete coverage of the torus. The four 3500 l/s turbopumps which were formerly used in the pumping duct will be mounted on the antechamber. The manipulator will utilize two end effectors. The first, called a General Inspection Arm (GIA) provides a movable platform to an inspection camera and an in-vacuum leak detector. The second is a bilateral, force-reflecting pair of slave arms which utilize specially developed tools to perform several maintenance functions. All components except the slave arms are capable of operating in TFTR's vacuum environment and during 150 0 C bakeout of the torus. (orig.)

  14. Manipulating Combinatorial Structures.

    Science.gov (United States)

    Labelle, Gilbert

    This set of transparencies shows how the manipulation of combinatorial structures in the context of modern combinatorics can easily lead to interesting teaching and learning activities at every level of education from elementary school to university. The transparencies describe: (1) the importance and relations of combinatorics to science and…

  15. Disorders of spinal blood circulation

    OpenAIRE

    Hevyak, O.M.; Kuzminskyy, A.P.

    2017-01-01

    Spinal strokes are rare. The most common causes of the haemorrhage are spinal cord trauma, vasculitis with signs of haemorrhagic diathesis, spinal vascular congenital anomalies (malformations) and haemangioma. By localization, haemorrhagic strokes are divided into three groups: haematomyelia, spinal subarachnoid haemorrhage, epidural hematoma. Most cavernous malformations are localized at the cervical level, fewer — at thoracic and lumbar levels of the spinal cord. The clinical case of diagno...

  16. Normal tissue tolerance to external beam radiation therapy: Spinal cord; Tolerance a l'irradiation des tissus sains: moelle epiniere

    Energy Technology Data Exchange (ETDEWEB)

    Habrand, J.L. [Departement de radiotherapie, institut Gustave-Roussy, 94 - Villejuif (France); Centre de protontherapie, institut Curie, 91 - Orsay (France); Drouet, F. [Departement de radiotherapie, centre Rene-Gauducheau, 44 - Nantes (France)

    2010-07-15

    Radiation myelopathy is one of the most dreadful complications of radiation therapy. Despite multiple animal experiments and human autopsic series, its pathogenesis remains largely unknown. In most instances, the classical aspect of myelomalacia combines glial and vascular injuries in various sequences. Recent studies point out the role of oligo-dendrocytes and their precursors, as well as of intercellular mediators (cytokines and stress molecules). The clinical presentation comprises a spectrum of non specific neurological symptoms whose evolution is sometimes regressive but more commonly progressive and life-threatening. Usually, it occurs following a latent period of six months to two years after irradiation of the cervical, thoracic or upper lumbar spine to a dose in excess of 50 Gy, conventionally fractionated. Nonetheless, these typical features can be altered by extrinsic factors, such as hypo fractionation/acceleration of the dose, multiple surgical procedures, chemotherapy especially mega therapy, or neurotoxic drugs. Conversely, hyperfractionated regimens that take into account protracted half-time repair of sublethal damages to the CNS, as well as sophisticated estimates of the dose to the cord and QA programs during the treatment course minimize such risks. (authors)

  17. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Disabilities Photography by Rona Talcott Website by Mobile Marketing LLC Understanding Spinal Cord Injury About Us Expert ... Disabilities Photography by Rona Talcott Website by Mobile Marketing LLC close close

  18. Spinal cord trauma

    Science.gov (United States)

    ... PA: Elsevier Saunders; 2015:chap 32. Kaji AH, Newton EJ, Hockberger RS. Spinal injuries. In: Marx JA, ... member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www. ...

  19. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... How Peer Counseling Works Julie Gassaway, MS, RN Pediatric Injuries Pediatric Spinal Cord Injury 101 Lawrence Vogel, MD The Basics of Pediatric SCI Rehabilitation Sara Klaas, MSW Transitions for Children ...

  20. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... com is an informational and support website for families facing spinal cord injuries. The website does not provide medical advice, recommend or endorse health care products or ...

  1. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Diane M. Rowles, MS, NP How Family Life Changes After Spinal Cord Injury Nancy Rosenberg, PsyD Understanding SCI Rehabilitation Donald Peck Leslie, MD Adjusting to Social Life in a Wheelchair Lisa Rosen, MS Spasticity, ...

  2. Spinal pain in adolescents

    DEFF Research Database (Denmark)

    Aartun, Ellen; Hartvigsen, Jan; Wedderkopp, Niels

    2014-01-01

    BACKGROUND: The severity and course of spinal pain is poorly understood in adolescents. The study aimed to determine the prevalence and two-year incidence, as well as the course, frequency, and intensity of pain in the neck, mid back, and low back (spinal pain). METHODS: This study was a school......-based prospective cohort study. All 5th and 6th grade students (11-13 years) at 14 schools in the Region of Southern Denmark were invited to participate (N = 1,348). Data were collected in 2010 and again two years later, using an e-survey completed during school time. RESULTS: The lifetime prevalence of spinal pain...... reported their pain as relatively infrequent and of low intensity, whereas the participants with frequent pain also experienced pain of higher intensity. The two-year incidence of spinal pain varied between 40% and 60% across the physical locations. Progression of pain from one to more locations and from...

  3. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... does not provide medical advice, recommend or endorse health care products or services, or control the information ... With Disabilities Photography by Rona Talcott Website by Mobile Marketing LLC Understanding Spinal Cord Injury About Us ...

  4. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Anne Bryden, OT The Role of the Social Worker after Spinal Cord Injury Patti Rogers, SW Marguerite ... arrow Why are high-dose steroids often used right after an injury? play_arrow What is meant ...

  5. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Living with SCI Personal Experiences by Topic Resources Peer Counseling Blog About Media Donate close search Understanding ... Living with SCI Personal Experiences by Topic Resources Peer Counseling Blog About Media Donate Spinal Cord Injury ...

  6. Spinal Injury: First Aid

    Science.gov (United States)

    ... EmergencyManual/WhatToDoInMedicalEmergency/Default.aspx?id=258&terms=spinal+injuries. Accessed Jan. 8, 2015. Marx JA, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa.: Mosby ...

  7. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Injury Diane M. Rowles, MS, NP How Family Life Changes After Spinal Cord Injury Nancy Rosenberg, PsyD ... Rehabilitation Donald Peck Leslie, MD Adjusting to Social Life in a Wheelchair Lisa Rosen, MS Spasticity, Physical ...

  8. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... With Disabilities Photography by Rona Talcott Website by Mobile Marketing LLC Understanding Spinal Cord Injury About Us ... With Disabilities Photography by Rona Talcott Website by Mobile Marketing LLC close close

  9. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Anne Bryden, OT The Role of the Social Worker after Spinal Cord Injury Patti Rogers, SW Marguerite ... or endorse health care products or services, or control the information found on external websites. The Hill ...

  10. Spinal Cord Injury 101

    Science.gov (United States)

    ... With Disabilities Photography by Rona Talcott Website by Mobile Marketing LLC Understanding Spinal Cord Injury About Us Expert ... With Disabilities Photography by Rona Talcott Website by Mobile Marketing LLC close close

  11. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... With Disabilities Photography by Rona Talcott Website by Mobile Marketing LLC Understanding Spinal Cord Injury About Us Expert ... With Disabilities Photography by Rona Talcott Website by Mobile Marketing LLC close close

  12. Spinal Cord Injury 101

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    Full Text Available ... Medical Experts People Living with SCI Personal Experiences by Topic Resources Peer ... Injuries Spinal Cord Injury 101 David Chen, MD Preventing Pressure Sores Mary Zeigler, MS Transition from Hospital to ...

  13. Spinal Cord Injury 101

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    Full Text Available ... OT Anne Bryden, OT The Role of the Social Worker after Spinal Cord Injury Patti Rogers, SW ... Experiences By Topic Resources Blog Peer Counseling About Media Donate Contact Us Terms of Use Site Map ...

  14. Spinal Cord Injury 101

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    Full Text Available ... SCI Rehabilitation Donald Peck Leslie, MD Adjusting to Social Life in a Wheelchair Lisa Rosen, MS Spasticity, ... OT Anne Bryden, OT The Role of the Social Worker after Spinal Cord Injury Patti Rogers, SW ...

  15. Spinal Cord Injury 101

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    Full Text Available ... Living with SCI Personal Experiences by Topic Resources Peer ... Adult Injuries Spinal Cord Injury 101 David Chen, MD Preventing Pressure Sores Mary Zeigler, MS Transition from Hospital to ...

  16. Spinal Cord Injury 101

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    Full Text Available ... arrow What is the “Spinal Cord Injury Model Systems” program? play_arrow ... recommend or endorse health care products or services, or control the information found on external websites. The Hill Foundation is ...

  17. Spinal Cord Injury 101

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    Full Text Available ... arrow What is the “Spinal Cord Injury Model Systems” program? play_arrow What are the most promising ... health care products or services, or control the information found on external websites. The Hill Foundation is ...

  18. Spinal Cord Injury 101

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    Full Text Available ... Experts People Living with SCI Personal Experiences by Topic Resources Peer Counseling Blog About Media Donate close ... Experts People Living with SCI Personal Experiences by Topic Resources Peer Counseling Blog About Media Donate Spinal ...

  19. IgG4-related spinal pachymeningitis.

    Science.gov (United States)

    Lu, Zhang; Tongxi, Liu; Jie, Luo; Yujuan, Jiao; Wei, Jiang; Xia, Liu; Yumin, Zheng; Xin, Lu

    2016-06-01

    The aim of this study is to study the clinical, laboratory, imaging pathology, and prognosis features of IgG4-related spinal pachymeningitis. We worked with a 55-year-old man suffering from IgG4-related spinal pachymeningitis who had the most widespread lesion in his dura mater. We also review previous related studies and discuss the clinical characteristics of this rare disease. In total, eight IgG4-related spinal pachymeningitis patients have been reported in the literature since 2009. They were mostly male patients, 51.7 ± 11.9 years old on average. Cervical and thoracic vertebrae were the most common sites for lesions. The most prominent symptom was varying numbness and weakness of the limbs and/or body associated with spinal cord compression. There was one patient (1/5) with elevated serum IgG4 levels and three patients (3/3) with increased cerebrospinal fluid (CSF) IgG4 index. Positive histopathologic findings are the strongest basis for a diagnosis. All the patients with IgG4-related spinal pachymeningitis responded well to glucocorticoid therapy. IgG4-related spinal pachymeningitis is an orphan disease that mainly occurs in cervical and thoracic vertebrae. Older males are the most susceptible group. Serum IgG4 levels were consistently normal in these cases, so analysis of CSF for IgG4 production (IgG4 index) could become a useful tool. Pathological findings remain the gold standard for diagnosis. Most patients responded favorably to glucocorticoid treatment.

  20. Spinal extradural arachnoid cysts

    Directory of Open Access Journals (Sweden)

    Abolfazl Rahimizadeh

    2013-01-01

    Full Text Available OBJECTIVE: Extradural arachnoid cysts (EACs are rare causes of spinal cord compression and cauda equina. These benign lesions appear in the literature mainly as single case reports. In this article, we present the largest series found in literature, with four new cases of spinal extradural arachnoid cysts. The characteristic imaging features, details of surgical steps and strategies to prevent postoperative kyphosis in this cystic pathology will be discussed.

  1. Myelopathy due to Spinal Extramedullary Hematopoiesis in a Patient with Polycythemia Vera.

    Science.gov (United States)

    Ito, Shuhei; Fujita, Nobuyuki; Hosogane, Naobumi; Nagoshi, Narihito; Yagi, Mitsuru; Iwanami, Akio; Watanabe, Kota; Tsuji, Takashi; Nakamura, Masaya; Matsumoto, Morio; Ishii, Ken

    2017-01-01

    Extramedullary hematopoiesis (EMH) occasionally occurs in patients exhibiting hematological disorders with decreased hematopoietic efficacy. EMH is rarely observed in the spinal epidural space and patients are usually asymptomatic. In particular, in the patients with polycythemia vera, spinal cord compression due to EMH is extremely rare. We report a case of polycythemia vera, in which operative therapy proved to be an effective treatment for myelopathy caused by spinal EMH.

  2. Myelopathy due to Spinal Extramedullary Hematopoiesis in a Patient with Polycythemia Vera

    OpenAIRE

    Ito, Shuhei; Fujita, Nobuyuki; Hosogane, Naobumi; Nagoshi, Narihito; Yagi, Mitsuru; Iwanami, Akio; Watanabe, Kota; Tsuji, Takashi; Nakamura, Masaya; Matsumoto, Morio; Ishii, Ken

    2017-01-01

    Extramedullary hematopoiesis (EMH) occasionally occurs in patients exhibiting hematological disorders with decreased hematopoietic efficacy. EMH is rarely observed in the spinal epidural space and patients are usually asymptomatic. In particular, in the patients with polycythemia vera, spinal cord compression due to EMH is extremely rare. We report a case of polycythemia vera, in which operative therapy proved to be an effective treatment for myelopathy caused by spinal EMH.

  3. Myelopathy due to Spinal Extramedullary Hematopoiesis in a Patient with Polycythemia Vera

    Directory of Open Access Journals (Sweden)

    Shuhei Ito

    2017-01-01

    Full Text Available Extramedullary hematopoiesis (EMH occasionally occurs in patients exhibiting hematological disorders with decreased hematopoietic efficacy. EMH is rarely observed in the spinal epidural space and patients are usually asymptomatic. In particular, in the patients with polycythemia vera, spinal cord compression due to EMH is extremely rare. We report a case of polycythemia vera, in which operative therapy proved to be an effective treatment for myelopathy caused by spinal EMH.

  4. Effectiveness of manual therapies: the UK evidence report.

    Science.gov (United States)

    Bronfort, Gert; Haas, Mitch; Evans, Roni; Leininger, Brent; Triano, Jay

    2010-02-25

    The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions. The conclusions are based on the results of systematic reviews of randomized clinical trials (RCTs), widely accepted and primarily UK and United States evidence-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories. The strength/quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs. By September 2009, 26 categories of conditions were located containing RCT evidence for the use of manual therapy: 13 musculoskeletal conditions, four types of chronic headache and nine non-musculoskeletal conditions. We identified 49 recent relevant systematic reviews and 16 evidence-based clinical guidelines plus an additional 46 RCTs not yet included in systematic reviews and guidelines.Additionally, brief references are made to other effective non-pharmacological, non-invasive physical treatments. Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1

  5. Effectiveness of manual therapies: the UK evidence report

    Directory of Open Access Journals (Sweden)

    Leininger Brent

    2010-02-01

    Full Text Available Abstract Background The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions. Methods The conclusions are based on the results of systematic reviews of randomized clinical trials (RCTs, widely accepted and primarily UK and United States evidence-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories. The strength/quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs. Results By September 2009, 26 categories of conditions were located containing RCT evidence for the use of manual therapy: 13 musculoskeletal conditions, four types of chronic headache and nine non-musculoskeletal conditions. We identified 49 recent relevant systematic reviews and 16 evidence-based clinical guidelines plus an additional 46 RCTs not yet included in systematic reviews and guidelines. Additionally, brief references are made to other effective non-pharmacological, non-invasive physical treatments. Conclusions Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and

  6. Pediatric spinal infections

    Directory of Open Access Journals (Sweden)

    Raj Kumar

    2014-01-01

    Full Text Available The infections of the spinal axis in children are rare when compared with adults. They encompass a large spectrum of diseases ranging from relatively benign diskitis to spinal osteomyleitis and to the rapidly progressive, rare, and potentially devastating spinal epidural, subdural, and intramedullary spinal cord infections. We present a comprehensive review of the literature pertaining to these uncommon entities, in light of our experience from northern India. The most prevalent pediatric spinal infection in Indian scenario is tuberculosis, where an extradural involvement is more common than intradural. The craniovertebral junction is not an uncommon site of involvement in children of our milieu. The majority of pyogenic infections of pediatric spine are associated with congenital neuro-ectodermal defects such as congenital dermal sinus. The clinico-radiological findings of various spinal infections commonly overlap. Hence the endemicity of certain pathogens should be given due consideration, while considering the differential diagnosis. However, early suspicion, rapid diagnosis, and prompt treatment are the key factors in avoiding neurological morbidity and deformity in a growing child.

  7. A universal microscope manipulator

    Directory of Open Access Journals (Sweden)

    Peter S. Boyadzhiev

    2012-03-01

    Full Text Available A modified and improved model of a mechanical manipulator for observation of pinned and mounted insects is described. This device allows movement of the observed object around three perpendicular axes in the field of vision at all magnifications of stereomicroscopes. The main improvement of this new model is positioning of the guiding knobs for rotating around two of the axes next to each other, allowing faster and easier manipulation of the studied object. Thus, one of the main advantages of this device is the possibility to rotate the specimen without the need to refocus. The device enables easily reaching a precession deviation in the intersection point of axes up to 0.5 mm in the process of assembling.

  8. Spinal and bulbar muscular atrophy.

    Science.gov (United States)

    Lieberman, Andrew P

    2018-01-01

    Spinal and bulbar muscular atrophy (SBMA) is an adult-onset degenerative disorder of the neuromuscular system resulting in slowly progressive weakness and atrophy of the proximal limb and bulbar muscles. The disease is caused by the expansion of a CAG/glutamine tract in the amino-terminus of the androgen receptor. That SBMA exclusively affects males reflects the fact that critical pathogenic events are hormone-dependent. These include translocation of the polyglutamine androgen receptor from the cytoplasm to the nucleus and unfolding of the mutant protein. Studies of the pathology of SBMA subjects have revealed nuclear aggregates of the mutant androgen receptor, loss of lower motor neurons in the brainstem and spinal cord, and both neurogenic and myopathic changes in skeletal muscle. Mechanisms underlying disease pathogenesis include toxicity in both lower motor neurons and skeletal muscle, where effects on transcription, intracellular transport, and mitochondrial function have been documented. Therapies to treat SBMA patients remain largely supportive, although experimental approaches targeting androgen action or promoting degradation of the mutant androgen receptor protein or the encoding RNA are under active study. Copyright © 2018 Elsevier B.V. All rights reserved.

  9. Microradiographic microsphere manipulator

    International Nuclear Information System (INIS)

    Singleton, R.M.

    1980-01-01

    A method and apparatus are provided for radiographic characterization of small hollow spherical members (microspheres), constructed of either optically transparent or opaque materials. The apparatus involves a microsphere manipulator which holds a batch of microspheres between two parallel thin plastic films for contact microradiographic characterization or projection microradiography thereof. One plastic film is translated to relative to and parallel to the other to roll the microspheres through any desired angle to allow different views of the microspheres

  10. Manipulation of quantum evolution

    Science.gov (United States)

    Cabera, David Jose Fernandez; Mielnik, Bogdan

    1994-01-01

    The free evolution of a non-relativistic charged particle is manipulated using time-dependent magnetic fields. It is shown that the application of a programmed sequence of magnetic pulses can invert the free evolution process, forcing an arbitrary wave packet to 'go back in time' to recover its past shape. The possibility of more general operations upon the Schrodinger wave packet is discussed.

  11. Manipulating atoms with photons

    International Nuclear Information System (INIS)

    Cohen-Tannoudji, C.N.

    1998-01-01

    The article is a translation of the lecture delivered on the occasion of the 1997 Nobel Prize awarding ceremony. The physical mechanisms which allow manipulating of neutral atoms with laser photons are described. A remark is also made concerning several possible applications of ultra-cool atoms and streams of future research. The article is completed by Prof. Cohen-Tannoudji's autobiography. (Z.J.)

  12. Delayed radiation necrosis of a spinal nerve root presenting as an intra-spinal mass

    International Nuclear Information System (INIS)

    Mikhael, M.A.

    1979-01-01

    Details are given of the case history of a 16 year old male with a six week history of progressive weakness of the arms and legs seven years after his last course of radiotherapy for Hodgkin's disease. Histopathological examination of an excised hard fibrotic mass revealed delayed radiation necrosis of a spinal root nerve with no evidence of Hodgkin's disease. The mass recurred seven months later and was removed by wide excision. The spinal cord had probably received less than 2000 rad during one course of radiotherapy. The 15 MeV electron beam of the second course of radiotherapy would not have penetrated the spinal cord itself, but the nerve roots would have received a much higher dose. Nerve roots should therefore be shielded whenever possible during radiotherapy, and the possibility of radiation necrosis considered in the differential diagnosis of intraspinal masses in the field of earlier radiation therapy. (UK)

  13. The efficacy of chiropractic manipulation for back pain : Blinded review of relevant randomized clinical trials

    NARCIS (Netherlands)

    Assendelft, W. J J; Koes, B. W.; Van der Heijden, G. J M G; Bouter, L. M.

    1992-01-01

    Objective: To assess the efficacy of chiropractic for patients with back pain. Data Sources: Randomized clinical trials (RCTs) on spinal manipulation were identified with a Medline search (1966-1990), by citation tracking, and by manual examination of the relevant chiropractic reference systems

  14. Protozoa manipulation by ultrasound

    Directory of Open Access Journals (Sweden)

    Yancy Milena Porras Rodríguez

    2004-01-01

    Full Text Available Microorganism manipulation, considered as controlled motion and positioning, is one of the most important activities in microbiology and medicine. To achieve this goal there are some techniques such as those which and optical forces, among others. These techniques are usually sophisticated, and some of them can induce irreversible alterations on the microorganisms which prevents their use in another tests. Thus, there is justified the study of technological alternatives to manipulate microorganisms in an easy and cost-effective way. This work shows the interaction between protozoa and air microbubbles when they are under the influence of an ultrasonic field of 5.8 mW. At the microbubbles resonant frequencies, microorganisms were attracted toward the bubbles' frontier remaining there while the ultrasonic field was applied. Once the ultrasound disappears, protozoa recover their freedom of movement. The observed effects could be used as the actuation principle of devices capable to trap, hold and release microorganisms of high mobility without any apparent damage. Microbubbles are generated by electrolysis which take place on the surface of an electrode array, while the ultrasound is originated by means of a piezoelectric transducer. As microorganisms there were employed those present in stagnated water, and were observed through an stereomicroscope. Key words: manipulator; protozoa; ultrasonic; transducer; piezoelectric.

  15. Pose Space Surface Manipulation

    Directory of Open Access Journals (Sweden)

    Yusuke Yoshiyasu

    2012-01-01

    Full Text Available Example-based mesh deformation techniques produce natural and realistic shapes by learning the space of deformations from examples. However, skeleton-based methods cannot manipulate a global mesh structure naturally, whereas the mesh-based approaches based on a translational control do not allow the user to edit a local mesh structure intuitively. This paper presents an example-driven mesh editing framework that achieves both global and local pose manipulations. The proposed system is built with a surface deformation method based on a two-step linear optimization technique and achieves direct manipulations of a model surface using translational and rotational controls. With the translational control, the user can create a model in natural poses easily. The rotational control can adjust the local pose intuitively by bending and twisting. We encode example deformations with a rotation-invariant mesh representation which handles large rotations in examples. To incorporate example deformations, we infer a pose from the handle translations/rotations and perform pose space interpolation, thereby avoiding involved nonlinear optimization. With the two-step linear approach combined with the proposed multiresolution deformation method, we can edit models at interactive rates without losing important deformation effects such as muscle bulging.

  16. Congenital spinal malformations; Kongenitale spinale Malformationen

    Energy Technology Data Exchange (ETDEWEB)

    Ertl-Wagner, B.B.; Reiser, M.F. [Klinikum Grosshadern, Ludwig-Maximilians-Univ. Muenchen (Germany). Inst. fuer Klinische Radiologie

    2001-12-01

    Congenital spinal malformations form a complex and heterogeneous group of disorders whose pathogenesis is best explained embryologically. Radiologically, it is important to formulate a diagnosis when the disorder first becomes symptomatic. However, it is also crucial to detect complications of the disorder or of the respective therapeutic interventions in the further course of the disease such as hydromyelia or re-tethering after repair of a meningomyelocele. Moreover, once a congenital spinal malformation is diagnosed, associated malformations should be sought after. A possible syndromal classification such as in OEIS- or VACTERL-syndromes should also be considered. (orig.) [German] Kongenitale spinale Malformationen stellen eine komplexe Gruppe an Stoerungen dar, deren Genese sich am einfachsten aus der Embryologie heraus erklaeren laesst. Bei der klinisch-radiologischen Begutachtung ist zunaechst ihre korrekte Klassifikation im Rahmen der Erstdiagnose wichtig. Im weiteren Verlauf ist es jedoch zudem entscheidend, moegliche Komplikationen wie beispielsweise eine Hydromyelie oder ein Wiederanheften des Myelons nach Operation einer Spina bifida aperta zu erkennen. Zudem sollte bei der Diagnosestellung einer kongenitalen spinalen Malformation immer auch auf assoziierte Fehlbildungen, wie z.B. die Diastematomyelie oder das intraspinale Lipom bei der Spina bifida aperta, sowie auf eine moegliche syndromale Einordnung wie beispielsweise beim OEIS-oder VACTERL-Syndrom geachtet werden. (orig.)

  17. Manipulation af hvirvelsøjlen ved kronisk rygsmerte--en gennemgang af et Cochranereview

    DEFF Research Database (Denmark)

    Bendix, Tom

    2011-01-01

    A new Cochrane review based on 26 studies - 18 new since the last Cochrane review from 2003 - on spinal manipulation for chronic low back pain has been published by Rubinstein et al. Generally, manipulation for these patients was not clinically relevant better than other treatments like e.g. phys.......g. physical training. In general, the widespread use of manipulation should be reduced. The issues of specific subgroups with possible relevance/irrelevance of such treatment to obtain short-lasting pain relief in selected cases are discussed....

  18. Management of Penetrating Spinal Cord Injuries in a Non Spinal ...

    African Journals Online (AJOL)

    Management of Penetrating Spinal Cord Injuries in a Non Spinal Centre: Experience at Enugu, Nigeria. ... The thoracic spine{9(41%)}was most often involved. ... Five (23%) patients with injury at cervical level died from respiratory failure.

  19. Continuous spinal anesthesia.

    Science.gov (United States)

    Moore, James M

    2009-01-01

    Continuous spinal anesthesia (CSA) is an underutilized technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows incremental dosing of an intrathecal local anesthetic for an indefinite duration, whereas traditional single-shot spinal anesthesia usually involves larger doses, a finite, unpredictable duration, and greater potential for detrimental hemodynamic effects including hypotension, and epidural anesthesia via a catheter may produce lesser motor block and suboptimal anesthesia in sacral nerve root distributions. This review compares CSA with other anesthetic techniques and also describes the history of CSA, its clinical applications, concerns regarding neurotoxicity, and other pharmacologic implications of its use. CSA has seen a waxing and waning of its popularity in clinical practice since its initial description in 1907. After case reports of cauda equina syndrome were reported with the use of spinal microcatheters for CSA, these microcatheters were withdrawn from clinical practice in the United States but continued to be used in Europe with no further neurologic sequelae. Because only large-bore catheters may be used in the United States, CSA is usually reserved for elderly patients out of concern for the risk of postdural puncture headache in younger patients. However, even in younger patients, sometimes the unique clinical benefits and hemodynamic stability involved in CSA outweigh concerns regarding postdural puncture headache. Clinical scenarios in which CSA may be of particular benefit include patients with severe aortic stenosis undergoing lower extremity surgery and obstetric patients with complex heart disease. CSA is an underutilized technique in modern anesthesia practice. Perhaps more accurately termed fractional spinal anesthesia, CSA involves intermittent dosing of local anesthetic solution via an intrathecal catheter. Where traditional spinal anesthesia involves a single injection with a

  20. Using Manipulatives in Math Instruction.

    Science.gov (United States)

    Marzola, Eileen S.

    1987-01-01

    Guidelines for teachers to better use manipulatives in the teaching of mathematics to learning disabled learners are offered including a rationale for manipulatives, selection crteria, principles underlying productive use of manipulatives, and making the transition from the concrete to the symbolic. Suggested materials and distributors are listed.…

  1. Bowel sparing in pediatric cranio-spinal radiotherapy: a comparison of combined electron and photon and helical TomoTherapy techniques to a standard photon method

    International Nuclear Information System (INIS)

    Harron, Elizabeth; Lewis, Joanne

    2012-01-01

    The aim of this study was to compare the dose to organs at risk (OARs) from different craniospinal radiotherapy treatment approaches available at the Northern Centre for Cancer Care (NCCC), with a particular emphasis on sparing the bowel. Method: Treatment plans were produced for a pediatric medulloblastoma patient with inflammatory bowel disease using 3D conformal 6-MV photons (3DCP), combined 3D 6-MV photons and 18-MeV electrons (3DPE), and helical photon TomoTherapy (HT). The 3DPE plan was a modification of the standard 3DCP technique, using electrons to treat the spine inferior to the level of the diaphragm. The plans were compared in terms of the dose-volume data to OARs and the nontumor integral dose. Results: The 3DPE plan was found to give the lowest dose to the bowel and the lowest nontumor integral dose of the 3 techniques. However, the coverage of the spine planning target volume (PTV) was least homogeneous using this technique, with only 74.6% of the PTV covered by 95% of the prescribed dose. HT was able to achieve the best coverage of the PTVs (99.0% of the whole-brain PTV and 93.1% of the spine PTV received 95% of the prescribed dose), but delivered a significantly higher integral dose. HT was able to spare the heart, thyroid, and eyes better than the linac-based techniques, but other OARs received a higher dose. Conclusions: Use of electrons was the best method for reducing the dose to the bowel and the integral dose, at the expense of compromised spine PTV coverage. For some patients, HT may be a viable method of improving dose homogeneity and reducing selected OAR doses.

  2. Spinal and Paraspinal Ewing Tumors

    International Nuclear Information System (INIS)

    Indelicato, Daniel J.; Keole, Sameer R.; Shahlaee, Amir H.; Morris, Christopher G.; Gibbs, C. Parker; Scarborough, Mark T.; Pincus, David W.; Marcus, Robert B.

    2010-01-01

    Purpose: To perform a review of the 40-year University of Florida experience treating spinal and paraspinal Ewing tumors. Patients and Methods: A total of 27 patients were treated between 1965 and 2007. For local management, 21 patients were treated with radiotherapy (RT) alone and 6 with surgery plus RT. All patients with metastatic disease were treated with RT alone. The risk profiles of each group were otherwise similar. The median age was 17 years, and the most frequent subsite was the sacral spine (n = 9). The median potential follow-up was 16 years. Results: The 5-year actuarial overall survival, cause-specific survival, and local control rate was 62%, 62%, and 90%, respectively. For the nonmetastatic subset (n = 22), the 5-year overall survival, cause-specific survival, and local control rate was 71%, 71%, and 89%, respectively. The local control rate was 84% for patients treated with RT alone vs. 100% for those treated with surgery plus RT. Patients who were >14 years old and those who were treated with intensive therapy demonstrated superior local control. Of 9 patients in our series with Frankel C or greater neurologic deficits at presentation, 7 experienced a full recovery with treatment. Of the 27 patients, 37% experienced Common Toxicity Criteria Grade 3 or greater toxicity, including 2 deaths from sepsis. Conclusion: Aggressive management of spinal and paraspinal Ewing tumors with RT with or without surgery results in high toxicity but excellent local control and neurologic outcomes. Efforts should be focused on identifying disease amenable to combined modality local therapy and improving RT techniques.

  3. Restoring walking after spinal cord injury: operant conditioning of spinal reflexes can help.

    Science.gov (United States)

    Thompson, Aiko K; Wolpaw, Jonathan R

    2015-04-01

    People with incomplete spinal cord injury (SCI) frequently suffer motor disabilities due to spasticity and poor muscle control, even after conventional therapy. Abnormal spinal reflex activity often contributes to these problems. Operant conditioning of spinal reflexes, which can target plasticity to specific reflex pathways, can enhance recovery. In rats in which a right lateral column lesion had weakened right stance and produced an asymmetrical gait, up-conditioning of the right soleus H-reflex, which increased muscle spindle afferent excitation of soleus, strengthened right stance and eliminated the asymmetry. In people with hyperreflexia due to incomplete SCI, down-conditioning of the soleus H-reflex improved walking speed and symmetry. Furthermore, modulation of electromyographic activity during walking improved bilaterally, indicating that a protocol that targets plasticity to a specific pathway can trigger widespread plasticity that improves recovery far beyond that attributable to the change in the targeted pathway. These improvements were apparent to people in their daily lives. They reported walking faster and farther, and noted less spasticity and better balance. Operant conditioning protocols could be developed to modify other spinal reflexes or corticospinal connections; and could be combined with other therapies to enhance recovery in people with SCI or other neuromuscular disorders. © The Author(s) 2014.

  4. Burkholderia thailandensis: Genetic Manipulation.

    Science.gov (United States)

    Garcia, Erin C

    2017-05-16

    Burkholderia thailandensis is a Gram-negative bacterium endemic to Southeast Asian and northern Australian soils. It is non-pathogenic; therefore, it is commonly used as a model organism for the related human pathogens Burkholderia mallei and Burkholderia pseudomallei. B. thailandensis is relatively easily genetically manipulated and a variety of robust genetic tools can be used in this organism. This unit describes protocols for conjugation, natural transformation, mini-Tn7 insertion, and allelic exchange in B. thailandensis. © 2017 by John Wiley & Sons, Inc. Copyright © 2017 John Wiley & Sons, Inc.

  5. Spatial manipulation with microfluidics

    Directory of Open Access Journals (Sweden)

    Benjamin eLin

    2015-04-01

    Full Text Available Biochemical gradients convey information through space, time, and concentration, and are ultimately capable of spatially resolving distinct cellular phenotypes, such as differentiation, proliferation, and migration. How these gradients develop, evolve, and function during development, homeostasis, and various disease states is a subject of intense interest across a variety of disciplines. Microfluidic technologies have become essential tools for investigating gradient sensing in vitro due to their ability to precisely manipulate fluids on demand in well controlled environments at cellular length scales. This minireview will highlight their utility for studying gradient sensing along with relevant applications to biology.

  6. A rare complication of spinal anesthesia: Intracranial subdural hemorrhage

    Directory of Open Access Journals (Sweden)

    Cengiz Kaplan

    2015-02-01

    Full Text Available Spinal (subarachnoid anesthesia (SA is a widely used general-purpose anesthesia. Postdural Puncture Headaches (PDPHs represent one of the principal complications of spinal anesthesia. A 21-year-old man underwent inguinal herniorrhaphy and orchiectomy using spinal anesthesia. Postoperatively, our patient started to have a headache with nausea. The patient received symptomatic therapy, but the severe headache persisted even in the supine position, with his vital signs and neurological examination being normal. Cranial MRI showed a bilateral subdural hematoma from his frontal to temporal region. A postdural puncture headache is a frequent complication after spinal anesthesia. However, serious complications, such as an intracranial subdural hemorrhage, can rarely occur. [Arch Clin Exp Surg 2015; 4(1.000: 54-56

  7. New Treatments for Spinal Nerve Root Avulsion Injury

    Directory of Open Access Journals (Sweden)

    Thomas Carlstedt

    2016-08-01

    Full Text Available Further progress in the treatment of the longitudinal spinal cord injury has been made. In an inverted translational study, it has been demonstrated that return of sensory function can be achieved by bypassing the avulsed dorsal root ganglion neurons. Dendritic growth from spinal cord sensory neurons could replace dorsal root ganglion axons and re-establish a reflex arch. Another research avenue has led to the development of adjuvant therapy for regeneration following dorsal root to spinal cord implantation in root avulsion injury. A small, lipophilic molecule that can be given orally acts on the retinoic acid receptor system as an agonist. Upregulation of dorsal root ganglion regenerative ability and organization of glia reaction to injury were demonstrated in treated animals. The dual effect of this substance may open new avenues for the treatment of root avulsion and spinal cord injuries.

  8. Potentialities of spinal liquor scanography

    International Nuclear Information System (INIS)

    Vlakhov, N.; Vylkanov, P.

    1986-01-01

    It is shown that spinal liquor scanography is a harmless and informative method for the examination of patients, permitting to detect injury foci for spinal cord tumours in 90% cases, for acute injuries of the vertebral column and spinal cord in 89.5% cases, for herniation of nucleus pulposus in 81% cases. The method of spinal liquor scanography can be used in neurology and neurosurgery to select the method of treatment and to evaluate its efficiency

  9. Remote control manipulator

    Energy Technology Data Exchange (ETDEWEB)

    Sugawara, T

    1970-02-28

    A prior-art remote control manipulator comprises a horizontal suspension section, a master arm and a slave arm which are coupled to ends of the suspension section in a manner to pivotally move relative to the suspension section, and a connecting device which includes a tape and which joins both the arms. When the connecting device malfunctions, the slave arm can neither be extended nor contracted. Means to keep the tension of the tape is required which restricts the extension length of the slave arm. Further, the slave arm can be moved only in the axial direction. The invention described provides an improved remote control manipulator of the specified type. A moving device which moves the slave arm relative to the master arm without the intervention of the connecting device is mounted on a movable part of the slave arm, while pulleys which maintain the joining relationship of the connecting device are mounted on the movable part and fixed part of the slave arm. Owing to this construction, movement of the slave arm is assured despite troubles which may arise in the connecting device. In addition, no slack arises in the tape. By applying a similar construction to the horizontal suspension section, the suspension section can be stretched, and hence, the slave arm can be moved in a direction orthogonal to its axis.

  10. Neuroradiology of the spinal canal

    International Nuclear Information System (INIS)

    Lehmann, R.; Molsen, H.P.

    1985-01-01

    Radiodiagnostics of the vertebral column and of the spinal cord under normal conditions and under different pathological alterations are elaborated. Especially cervical and thoracal myelography, lumbosacral myeloradiculography, spinal arteriography and phlebography as well as spinal computerized tomography are discussed in detail

  11. Spinal cord swelling and candidiasis

    International Nuclear Information System (INIS)

    Ho, K.; Gronseth, G.; Aldrich, M.; Williams, A.

    1982-01-01

    Fusiform swelling of the spinal cord was noted myelographically in a patient with Hodgkin's disease. Autopsy revealed that the swelling was cauused by Candida infection of the spinal cord. It is suggested that fungal infection be included in the differential diagnosis of spinal cord swelling in the immunsupporessed cancer patient. (orig.)

  12. Spinal cord swelling and candidiasis

    Energy Technology Data Exchange (ETDEWEB)

    Ho, K.; Gronseth, G.; Aldrich, M.; Williams, A.

    1982-11-01

    Fusiform swelling of the spinal cord was noted myelographically in a patient with Hodgkin's disease. Autopsy revealed that the swelling was caused by Candida infection of the spinal cord. It is suggested that fungal infection be included in the differential diagnosis of spinal cord swelling in the immunosuppressed cancer patient.

  13. Spinal CT scan, 2

    International Nuclear Information System (INIS)

    Nakagawa, Hiroshi

    1982-01-01

    Plain CT described fairly accurately the anatomy and lesions of the lumbar and sacral spines on their transverse sections. Since hernia of the intervertebral disc could be directly diagnosed by CT, indications of myelography could be restricted. Spinal-canal stenosis of the lumbar spine occurs because of various factors, and CT not only demonstrated the accurate size and morphology of bony canals, but also elucidated thickening of the joints and yellow ligament. CT was also useful for the diagnosis of tumors in the lumbar and sacral spines, visualizing the images of bone changes and soft tissues on the trasverse sections. But the diagnosis of intradural tumors required myelography and metrizamide CT. CT has become important for the diagnosis of spinal and spinal-cord diseases and for selection of the route of surgical arrival. (Chiba, N.)

  14. Intramedullary spinal melanocytoma

    Directory of Open Access Journals (Sweden)

    Meic H. Schmidt

    2010-06-01

    Full Text Available Meningeal melanocytoma is a benign lesion arising from leptomeningeal melanocytes that at times can mimic its malignant counterpart, melanoma. Lesions of the spine usually occur in extramedullary locations and present with spinal cord compression symptoms. Because most reported spinal cases occur in the thoracic region, these symptoms usually include lower extremity weakness or numbness. The authors present a case of primary intrame­dullary spinal meningeal melanocytoma presenting with bilateral lower extremity symptoms in which the patient had no known supratentorial primary lesions. Gross total surgical resection allowed for full recovery, but early recurrence of tumor was detected on close follow-up monitoring, allowing for elective local radiation without loss of neurological function. Case reports of such tumors discuss different treatment strategies, but just as important is the close follow-up monitoring in these patients even after gross total surgical resection, since these tumors can recur.

  15. Spinal Cord Stimulation

    DEFF Research Database (Denmark)

    Meier, Kaare

    2014-01-01

    Spinal cord stimulation (SCS) is a surgical treatment for chronic neuropathic pain that is refractory to other treatment. Originally described by Shealy et al. in 1967(1), it is used to treat a range of conditions such as complex regional pain syndrome (CRPS I)(2), angina pectoris(3), radicular...... pain after failed back surgery syndrome (FBSS)(4), pain due to peripheral nerve injury, stump pain(5), peripheral vascular disease(6) and diabetic neuropathy(7,8); whereas phantom pain(9), postherpetic neuralgia(10), chronic visceral pain(11), and pain after partial spinal cord injury(12) remain more...

  16. Congenital spinal malformations

    International Nuclear Information System (INIS)

    Ertl-Wagner, B.B.; Reiser, M.F.

    2001-01-01

    Congenital spinal malformations form a complex and heterogeneous group of disorders whose pathogenesis is best explained embryologically. Radiologically, it is important to formulate a diagnosis when the disorder first becomes symptomatic. However, it is also crucial to detect complications of the disorder or of the respective therapeutic interventions in the further course of the disease such as hydromyelia or re-tethering after repair of a meningomyelocele. Moreover, once a congenital spinal malformation is diagnosed, associated malformations should be sought after. A possible syndromal classification such as in OEIS- or VACTERL-syndromes should also be considered. (orig.) [de

  17. Spinal Neurocysticercosis: Case Report

    International Nuclear Information System (INIS)

    Amaya P, Melina; Roa, Jose L

    2011-01-01

    Neurocysticercosis (NCC) is the most frequent parasitic illness of the central nervous system caused by the larval form of Taenia solium and its considered to be endemic in Latin America. Its diagnosis is based on imaging findings and epidemiological data; although its diagnosis can be made through the detection of specific IgG antibodies, these tests have limited availability in our environment. Central nervous system involvement is generally observed in the brain parenchyma, and less commonly in the ventricular system and subarachnoid space; only infrequently is reported to involve the structures within the spinal canal, in this article we review a case of a patient with spinal cysticercal involvement.

  18. Neuroprotection and its molecular mechanism following spinal cord injury☆

    Science.gov (United States)

    Liu, Nai-Kui; Xu, Xiao-Ming

    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. PMID:25624837

  19. Hydraulic manipulator research at ORNL

    International Nuclear Information System (INIS)

    Kress, R.L.; Jansen, J.F.; Love, L.J.

    1997-01-01

    Recently, task requirements have dictated that manipulator payload capacity increase to accommodate greater payloads, greater manipulator length, and larger environmental interaction forces. General tasks such as waste storage tank cleanup and facility dismantlement and decommissioning require manipulator life capacities in the range of hundreds of pounds rather than tens of pounds. To meet the increased payload capacities demanded by present-day tasks, manipulator designers have turned once again to hydraulics as a means of actuation. In order to successfully design, build, and deploy a new hydraulic manipulator (or subsystem), sophisticated modeling, analysis, and control experiments are usually needed. Oak Ridge National Laboratory (ORNL) has a history of projects that incorporate hydraulics technology, including mobile robots, teleoperated manipulators, and full-scale construction equipment. In addition, to support the development and deployment of new hydraulic manipulators, ORNL has outfitted a significant experimental laboratory and has developed the software capability for research into hydraulic manipulators, hydraulic actuators, hydraulic systems, modeling of hydraulic systems, and hydraulic controls. The purpose of this article is to describe the past hydraulic manipulator developments and current hydraulic manipulator research capabilities at ORNL. Included are example experimental results from ORNL's flexible/prismatic test stand

  20. Hydraulic manipulator research at ORNL

    Energy Technology Data Exchange (ETDEWEB)

    Kress, R.L.; Jansen, J.F. [Oak Ridge National Lab., TN (United States); Love, L.J. [Oak Ridge Inst. for Science and Education, TN (United States)

    1997-03-01

    Recently, task requirements have dictated that manipulator payload capacity increase to accommodate greater payloads, greater manipulator length, and larger environmental interaction forces. General tasks such as waste storage tank cleanup and facility dismantlement and decommissioning require manipulator life capacities in the range of hundreds of pounds rather than tens of pounds. To meet the increased payload capacities demanded by present-day tasks, manipulator designers have turned once again to hydraulics as a means of actuation. In order to successfully design, build, and deploy a new hydraulic manipulator (or subsystem), sophisticated modeling, analysis, and control experiments are usually needed. Oak Ridge National Laboratory (ORNL) has a history of projects that incorporate hydraulics technology, including mobile robots, teleoperated manipulators, and full-scale construction equipment. In addition, to support the development and deployment of new hydraulic manipulators, ORNL has outfitted a significant experimental laboratory and has developed the software capability for research into hydraulic manipulators, hydraulic actuators, hydraulic systems, modeling of hydraulic systems, and hydraulic controls. The purpose of this article is to describe the past hydraulic manipulator developments and current hydraulic manipulator research capabilities at ORNL. Included are example experimental results from ORNL`s flexible/prismatic test stand.