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Study design:This is a systematic literature review.Objectives:Different types of orthoses have been developed to enable and facilitate ambulation in individuals with paraplegia. However, their effect on energy consumption while ambulating is not clear. The objective of this review was to compare the energy expenditure required to walk with these devices.Methods:Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, and based on selected keywords and their composition according to the Population Intervention Comparison Outcome (PICO) method, a search was performed in Science Direct, Google Scholar, Scopus, Web of Knowledge and PubMed databases. The searches were restricted to papers published in the English language and were conducted during February 2014; the last access to the database was on 25 February 2014. A total of 24 articles were chosen for final evaluation.Results:Hybrid orthoses reduce energy consumption compared with mechanical orthoses when used for walking by paraplegic patients. The isocentric reciprocating gait orthosis has been shown to be more effective than other reciprocating orthoses in reducing energy consumption. Energy consumption when walking with powered orthoses (PO) and hybrid orthoses was also reduced compared with when walking with conventional orthoses.Conclusions:The hybrid orthoses and PO could be effective alternatives in rehabilitation for spinal cord injury patients to help improve the energy consumption. [ABSTRACT FROM AUTHOR]

Objectives:The purpose of this paper is to describe the development and evaluation of a new medial linkage reciprocating gait orthosis (MLRGO) that incorporates a reciprocal mechanism and is sensitive to pelvic motion to potentially assist paraplegic patients to walk and provide functional independence.Case description and methods:The new orthosis was constructed and tested by a 20-year-old female paraplegic subject with transverse myelitis at T10 level, who was 4 years post injury and had also been an isocentric reciprocating gait orthosis (IRGO) user for 2 years. She received gait training for 12 weeks before undertaking gait analysis, and also completed a questionnaire that was designed to assess the perceived functionality of the new MLRGO when compared with an IRGO.Results:The results demonstrated improvements in gait velocity, step length and cadence, and also improvement in functional independence with the new orthosis compared with an IRGO.Conclusion:The results demonstrated that this new MLRGO could be used for paraplegic patients who would like an improvement in functional independence and ambulation. [ABSTRACT FROM AUTHOR]

Study design:Cross-sectional study.Objectives:The main goal of our study was to explore the differences in heart rate variability (HRV) while sitting between able-bodied (AB) participants and paraplegic (P) individuals.Setting:The study was conducted in the Physical Therapy department and the Physical Education and Sports department of the University of Valencia and Vall d'Hebrón Hospital.Methods:To record the HRV, a 1000-Hz Suunto Oy t6 heart rate monitor was used. The data were analyzed in the temporal and frequency domains, and nonlinear analysis was performed as well.Results:We found significant differences between P and AB participants in SDNN: t(76)=2.81, P<0.01; root mean squared of the difference of successive RR intervals: t(76)=2.35, P<0.05; very low frequency: t(76)=2.97, P<0.01; low frequency: t(41.06)=2.33, P<0.05; total power of the spectrum: t(45.74)=2.57, P<0.05; SD1: t(76)=2.35, P<0.05; SD2: t(76)=2.82, P<0.01. Furthermore, there is a reduced variability in the P participants who adopted a sedentary lifestyle as could be observed in detrended fluctuation1 t(40)=−2.10; P<0.05.Conclusion:Although individuals in the P group were more active in sports than the AB group, they had an altered HRV when compared with AB individuals. It could be important to develop more intense sports programs to improve cardiac vagal tone, which in turn produces a decrease in work and oxygen consumption of the heart. [ABSTRACT FROM AUTHOR]

Study Design:A longitudinal retrospective study.Objective:To better understand individual-level temporal change in functional status for participants with paraplegia in the National Spinal Cord Injury Database (NSCID), as measured by Rasch Transformed Motor Functional Indepedence Measure (FIM) scores.Setting:Multicenter/Multistate longitudinal study across the United States.Methods:Non-linear random effects modeling, that is, individual growth curve analysis of retrospective data obtained from the National Institute on Disability and Rehabilitation Research (NIDRR) NSCID.Results:We generated non-linear individual level trajectories of recovery for Rasch Transformed Motor FIM scores that rise rapidly from inpatient rehabilitation admission to a plateau. Trajectories are based on relationships between growth parameters and patient and injury factors: race, gender, level of education at admission, age at injury, neurological level at discharge, American Spinal Injury Association Impairment Scale (AIS) at discharge, days from injury to first system inpatient rehabilitation admission, rehabilitation length of stay, marital status and etiology. On the basis of study results, an interactive tool was developed to represent individual level longitudinal outcomes as trajectories based upon an individual's given baseline characteristics, that is, information supplied by the covariates and provides a robust description of temporal change for those with paraplegia within the NSCID.Conclusions:This methodology allows researchers and clinicians to generate and better understand patient-specific trajectories through the use of an automated interactive tool where a nearly countless number of longitudinal paths of recovery can be explored. Projected trajectories holds promise in facilitating planning for inpatient and outpatient services, which could positively impact long term outcomes. [ABSTRACT FROM AUTHOR]

Study design:A case report of a female patient who sustained injury to the thoracic spinal cord as a direct result of thoracolumbar selective nerve root block.Objective:To raise the awareness that selective nerve root infiltration, a very common procedure in a pre-existing deformity, may cause injury to the spinal cord with dire consequences, albeit rarely.Case report:An 82-year-old retired nurse (who had sustained osteoporotic compression fractures of the T12 vertebra) who presented with a 2-year history of continuous low back pain following a fall into a pothole. Immediately after image-guided, transforaminal infiltration of left side T12 root the patient developed sudden onset of complete motor and sensory T10 level flaccid paraplegia. No abnormality was noted on T2 magnetic resonance imaging (MRI) of the spine on the same day. Eleven days later, T2 MRI of the spine with gadolinium contrast revealed an increased fluid signal in conus medullaris. At 2-year follow-up, the neurological improvement has been good (L2 level American Spinal Injury Association/International Spinal Cord Society (ASIA/ISCoS) neurological standard scale (AIS) D paraplegia), urinary and sensory disorders are still present.Conclusion:Injury to the spinal cord is known to occur in interventions such as epidural steroid infiltrations. Over time, pain management in relation to the new and emerging interventions on spine have changed. What might not be appreciated is the awareness that such interventions may cause injury to the spinal cord with serious consequences. Despite potential occurrence, in the case reported here, the neurological and functional prognosis is good with an expert, early and appropriate management in a spinal injuries centre. [ABSTRACT FROM AUTHOR]