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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: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:Qualitative study.Objective:To determine categories of coping the first year after injury used by 24 young adults who sustained a spinal cord injury (SCI) during adolescence (11-15 years).Setting:Sweden.Methods:Content analysis using the existing theories of coping as a framework, including the instrument BriefCOPE-a deductive category application. The analysis looked critically at comments in the interviews that reflected attempts to cope with the injury during the first post-injury year.Results:All 14 of the categories of coping described by the BriefCOPE were included in the interviews at least once, except 'self-blame', which was not used by any interviewee. In addition to the predefined categories of the BriefCOPE, three new coping categories emerged from the interviews: fighting spirit, downward comparison and helping others.Conclusions:Adolescents who sustain SCIs use a variety of strategies to help them to cope with the consequences of the injury. Many of these coping strategies are similar to those used by others facing stresses, but it is instructive to hear, in their own words, how young adults recall the coping strategies they used as adolescents when they were injured and also how they conceptualized the process of coping. This information can be useful in helping future patients.Sponsorship:The study was supported by the Promobilia foundation and the Norrbacka-Eugenia foundation. [ABSTRACT FROM AUTHOR]

Study design:Controlled experimental human study.Objectives:To assess insulin resistance (IR) in tetraplegia and paraplegia, and the role of the spinal cord (SC) in glucose regulation.Setting:Laboratory of Spinal Research, Loewenstein Rehabilitation Hospital.Methods:Glucose and insulin levels and the heart rate variation spectral components LF (low frequency), HF (high frequency) and LF/HF were studied at supine rest, head-up tilt and after a standard meal in three groups: 13 healthy subjects, 7 patients with T4-T6 paraplegia and 11 patients with C4-C7 tetraplegia.Results:Glucose and insulin increased significantly after the meal in all groups (P<0.001). Glucose increased significantly more in the tetraplegia than in the other groups (P<0.01). Increases in insulin level tended to accompany increases in LF/HF after the meal in the tetraplegia and control groups but not in the paraplegia group.Conclusion:Post-prandial IR appears in C4-C7 but not in T4-T6 SC injury. The results of the study, combined with previously published findings, are consistent with the hypotheses that IR is related to activation of the sympathetic nervous system, and that below T4 the mid-thoracic SC is involved in the regulation of glucose and insulin levels. [ABSTRACT FROM AUTHOR]

Study design:Cross-sectional. Objectives: To describe self-identified indoor and outdoor wheelchair-oriented participation outcomes and to report satisfaction with the identified outcomes by people with spinal cord injury (SCI). Setting:Vancouver, British Columbia. Methods:Participation outcomes were identified using the Wheelchair Outcome Measure and classified using the International Classification of Functioning, Disability, and Health (ICF).Results: The average age of the 51 community-dwelling subjects with SCI was 43.7(±10.7) years. Of them, 84% were men, 64% had tetraplegia and 66% used a manual wheelchair. There were 258 indoor and 257 outdoor participation outcomes identified by this sample with most outcomes falling into the ‘community, social, and civil life’ (36.5%), ‘domestic life’ (23.7%) and ‘mobility’ (18%) domains of the ICF. All domains had a mean satisfaction score of 7.1/10 or greater except for the indoor ‘mobility’ domain that had a mean satisfaction score of 6.1/10. Satisfaction scores with performance of the specific participation outcomes ranged from high (10/10) to low (2/10) with most scores falling above 7/10. Conclusion: Community-dwelling people with SCI commonly engage in wheelchair-oriented participation outcomes related to ‘community, social, and civil life’, ‘domestic life’ and ‘mobility’ and tend to be satisfied with their performance of these participation outcomes. This information is useful for clinicians and may help to guide assessment and intervention. [ABSTRACT FROM AUTHOR]