Search

Traumatic atlantoaxial hyperflexion is considered rare in cats, and only a few case reports have been published. There are other conditions that can result in a peracute onset of neurological signs localized to the cervical spinal cord segments, including acute noncompressive nucleus pulposus extrusion, ischemic myelopathy, or vertebral fractures. Appropriate treatment for these conditions can only be initiated after an accurate diagnosis has been obtained. The aim of this observational, retrospective, single‐center, descriptive case series study was to describe the clinical presentation, imaging characteristics, and short‐term outcome of eight cats presented with suspected traumatic atlantoaxial hyperflexion. Young male healthy domestic shorthair cats were overrepresented (7/8) and typically presented with a peracute, nonprogressive, nonpainful, nonlateralizing C1–C5 myelopathy (tetraplegia or nonambulatory tetraparesis) following a road traffic accident or head trauma. All MRI studies demonstrated a solitary, focal, ill‐defined intramedullary lesion immediately dorsal to the dens of the axis, affecting both grey and white matter. All cats were treated medically. In 50% of the cats, the neurological grade improved at discharge or short‐term follow‐up, 25% of the cats recovered completely, one cat was static at short‐term follow‐up, and one cat was euthanized due to persistent forebrain signs and lack of neurological improvement. [ABSTRACT FROM AUTHOR]

Background and objective: Constraint-induced movement therapy is a widely used rehabilitation program in the stroke population, but its application in spinal cord injury is limited. The objective of the study is to determine the feasibility of modified constraint-induced movement therapy (mCIMT) in incomplete tetraplegia exhibiting upper limb weakness and activities of daily living (ADLs) difficulty. Method: This is a quasi-experimental one-group pilot study, consisting of 12 subjects diagnosed with incomplete tetraplegia. They received 2-h sessions of modified constraint-induced movement therapy of the weaker hand along with a 1-h session of bimanual massed practice, 5 days a week for 3 weeks. Apart from this, they were asked to do 3 h of constrained-induced movement therapy daily 5 days a week for 3 weeks at their home as a part of a home exercise program. Box and block test (BBT) and Spinal Cord Independence Measure version III (SCIM-III) were taken as the primary measure, and manual function test (MFT) and capabilities for upper extremity (CUE) were used as secondary measures to access hand functions and ADLs. Subjects were examined during pre-intervention and post-intervention. Results: After 3 weeks of intervention, the mean change of the score for the trained hand showed significant changes in the scores of the box and block test (p = 0.03), manual function test (p = 0.02), SCIM-III (p = 0.03), and CUE (p = 0.02). Conclusion: This preliminary study revealed that modified CIMT may be a feasible and effective alternative for hand rehabilitation in incomplete tetraplegia. [ABSTRACT FROM AUTHOR]

This scoping review aimed to map the breadth of available literature, and to understand the barriers and facilitators of return to study and education participation for students with SCI. The authors performed electronic searches of six databases for peer-reviewed articles published in English between January 1990 and March 2021. Key search terms included: spinal cord injury, students, education participation, academic reintegration, and school re-entry. Data charting was used to summarise the study characteristics. Eleven articles addressed the return to study and education participation of students with SCI. These studies used qualitative and quantitative methods and involved participants aged between 10 and 42 years. The findings addressed five main areas: importance of education, participation and performance in education, the physical environment, support network, and strategies for integration. This review shows that there is limited evidence available on this topic, mostly from small scale studies with variable quality. More research is needed to understand how best to support the educational participation and success of students with SCI. Policies targeted to mitigating barriers, including inaccessible environments and curricula, adequate information and supports, are also needed to better facilitate return to study and education participation of students with SCI. [ABSTRACT FROM AUTHOR]

Thermoregulation is impaired in individuals with a spinal cord lesion (SCI), affecting sweat capacity, heat loss, and core temperature. This can be particularly problematic for athletes with SCI who exercise in hot and humid conditions, like those during the Tokyo 2020 Paralympic Games. Heat acclimation can support optimal preparation for exercise in such challenging environments, but evidence is limited in endurance athletes with SCI. We evaluated whether seven consecutive days of exercise in the heat would result in heat acclimation. Five elite para-cycling athletes with SCI participated (two females, three males, median (Q1-Q3) 35 (31–51) years, four with paraplegia and one with tetraplegia). All tests and training sessions were performed in a heat chamber (30°C and 75% relative humidity). A time-to-exhaustion test was performed on day 1 (pretest) and day 7 (posttest). On days 2–6, athletes trained daily for one hour at 50–60% of individual peak power (PPeak). Comparing pretest and posttest, all athletes increased their body mass loss (p=0.04), sweat rate (p=0.04), and time to exhaustion (p=0.04). Effects varied between athletes for core temperature and heart rate. All athletes appeared to benefit from our heat acclimation protocol, helping to optimize their preparation for the Tokyo 2020 Paralympic Games. [ABSTRACT FROM AUTHOR]

(1) Background: The influence of robotic therapy on patients with sub-acute cervical spinal cord injury (SCI) for improving their activities of daily living (ADL) performance is unclear; (2) Methods: 31 subjects with cervical SCI completed the training randomly assigned to an intervention or control group during 40 sessions. All the subjects received, in each session, 30 min of upper-extremity conventional therapy. In addition, the subjects within the control group received another 30 min of conventional therapy, whereas subjects within the intervention group received 30 min of robotic therapy with Armeo Spring (Hocoma AG, Volketswil, Switzerland). Therefore, the ADL of drinking was trained by using the exoskeleton. Feasibility and efficacy measurements as clinical scales and kinematic indices, and usability questionnaires, were used as assessment at baseline and at the ending of the study (week 10); (3) Results: The intervention group significantly improved with regards to the feeding and grooming items of the Spinal Cord Independence Measure scale. The improvement in the movement smoothness related to the activity of drinking was greater in the intervention group than in the control (p = 0.034); (4) Conclusions: The findings of this study reveal that patients with cervical SCI improve their performance in ADL with robotic therapy. [ABSTRACT FROM AUTHOR]

This study addresses the need for highly sensitive tools to evaluate hand strength, particularly grasp and pinch strength, which are vital for diagnosing and rehabilitating conditions affecting hand function. Current devices like the Jamar dynamometer and Martin Vigorimeter, although reliable, fail to measure extremely low force or pressure values required for individuals with severe hand impairments. This research introduces a novel device, a modified Martin Vigorimeter, utilizing an ultra-soft latex chamber and differential pressure measurement to detect minute pressure changes, thus significantly enhancing sensitivity. The device offers a cost-effective solution, making advanced hand strength evaluation more accessible for clinical and research applications. Future research should validate its accuracy across diverse populations and settings, exploring its broader implications for hand rehabilitation and occupational health. [ABSTRACT FROM AUTHOR]

Abstract Background and objective Constraint-induced movement therapy is a widely used rehabilitation program in the stroke population, but its application in spinal cord injury is limited. The objective of the study is to determine the feasibility of modified constraint-induced movement therapy (mCIMT) in incomplete tetraplegia exhibiting upper limb weakness and activities of daily living (ADLs) difficulty. Method This is a quasi-experimental one-group pilot study, consisting of 12 subjects diagnosed with incomplete tetraplegia. They received 2-h sessions of modified constraint-induced movement therapy of the weaker hand along with a 1-h session of bimanual massed practice, 5 days a week for 3 weeks. Apart from this, they were asked to do 3 h of constrained-induced movement therapy daily 5 days a week for 3 weeks at their home as a part of a home exercise program. Box and block test (BBT) and Spinal Cord Independence Measure version III (SCIM-III) were taken as the primary measure, and manual function test (MFT) and capabilities for upper extremity (CUE) were used as secondary measures to access hand functions and ADLs. Subjects were examined during pre-intervention and post-intervention. Results After 3 weeks of intervention, the mean change of the score for the trained hand showed significant changes in the scores of the box and block test (p = 0.03), manual function test (p = 0.02), SCIM-III (p = 0.03), and CUE (p = 0.02). Conclusion This preliminary study revealed that modified CIMT may be a feasible and effective alternative for hand rehabilitation in incomplete tetraplegia.

Abstract Background Tetraplegia is a debilitating sequela of spinal cord injury (SCI). However, comprehensive approaches for determining the influence of various factors on activities of daily living (ADL) in patients with tetraplegia are limited. Therefore, this study aimed to determine the influence of physical factors on ADL in patients with tetraplegia after adjusting for demographic, SCI-related, and cognitive factors. Methods This retrospective cross-sectional study enrolled 201 patients with tetraplegia who underwent inpatient rehabilitation at the National Rehabilitation Center in South Korea between 2019 and 2021. Patients’ mean age was 50.5 years (standard deviation, 16.3), and 170 (84.6%) were men. The Korean Spinal Cord Independence Measure III (K-SCIM III) was used as the main outcome measure to assess patients’ ADL ability. Hierarchical multiple regression modeling was conducted with K-SCIM as the dependent variable to examine the level of functioning and relative influencing factors. Results Upper-extremity motor score (UEMS), upper-extremity spasticity and sitting balance scores were significant predictors of self-care; lower-extremity motor score (LEMS), musculoskeletal pain of shoulder, and sitting balance were significant predictors of respiratory and sphincter management; UEMS, LEMS, and sitting balance score were significant predictors of mobility; and UEMS, LEMS, musculoskeletal pain of shoulder, and sitting balance scores were significant predictors of the K-SCIM III total score after adjustment for demographic, SCI-related, and cognitive factors. Conclusions Physical factors had the greatest impact on all subscores and the K-SCIM III total score. Upper- and lower-extremity muscle strength and sitting balance significantly affected functional ability across all subscores.

Distal nerve transfers can restore precise motor control in tetraplegic patients. When nerve transfers are not successful, tendon transfers may be used for subsequent reconstruction. In this case, an extensor carpi radialis brevis (ECRB) tendon transfer was used to restore thumb and finger flexion following an unsuccessful ECRB to anterior interosseous nerve transfer in a young tetraplegic patient. Twelve months following tendon transfer, the patient demonstrated functional grip and pinch strength and was using both hands for daily activities. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

BACKGROUND To compare the pharmacological treatment of hypotension and orthostatic hypotension (OH) initiated based upon a blood pressure (BP) threshold, regardless of symptoms (TXT), to usual care pharmacological treatment of symptomatic hypotension (UC), during acute inpatient rehabilitation (AIR) following spinal cord injury (SCI). METHODS Block randomization, based on the neurological level of injury as: cervical lesions (C1–C8); high thoracic lesions (T1–T5), and low thoracic lesions (T6–T12), was used to determine responses to the primary question " was the therapy session affected by low BP or concern for low BP development? " Study participants and therapists were unaware of the group assignment. RESULTS A total of 66 participants enrolled; 25 (38%) in the TXT group, 29 (44%) in the UC group, and 12 (18%) withdrew. Responses to the primary question were recorded for 32 participants, 15 in the TXT, and 17 in the UC group. There was an average of 81 ± 51 therapy sessions/participant in the TXT and 60 ± 27 sessions/participant in the UC group. Of those therapy sessions, low BP or concerns for low BP affected an average of 9 ± 8 sessions/participant in the TXT group and 10 ± 12 sessions/participant in the UC group. Neither the total number of therapy sessions (P  = 0.16) nor group assignment (P  = 0.83) significantly predicted the number of sessions affected by low BP. CONCLUSIONS These data are not conclusive but indicate that the treatment of asymptomatic hypotension and OH does not increase time spent in therapy compared to UC treatment of symptomatic hypotension and OH in newly injured patients with SCI. CLINICAL TRIALS REGISTRATION #NCT02919917. [ABSTRACT FROM AUTHOR]

Background: Tetraplegia is a debilitating sequela of spinal cord injury (SCI). However, comprehensive approaches for determining the influence of various factors on activities of daily living (ADL) in patients with tetraplegia are limited. Therefore, this study aimed to determine the influence of physical factors on ADL in patients with tetraplegia after adjusting for demographic, SCI-related, and cognitive factors. Methods: This retrospective cross-sectional study enrolled 201 patients with tetraplegia who underwent inpatient rehabilitation at the National Rehabilitation Center in South Korea between 2019 and 2021. Patients' mean age was 50.5 years (standard deviation, 16.3), and 170 (84.6%) were men. The Korean Spinal Cord Independence Measure III (K-SCIM III) was used as the main outcome measure to assess patients' ADL ability. Hierarchical multiple regression modeling was conducted with K-SCIM as the dependent variable to examine the level of functioning and relative influencing factors. Results: Upper-extremity motor score (UEMS), upper-extremity spasticity and sitting balance scores were significant predictors of self-care; lower-extremity motor score (LEMS), musculoskeletal pain of shoulder, and sitting balance were significant predictors of respiratory and sphincter management; UEMS, LEMS, and sitting balance score were significant predictors of mobility; and UEMS, LEMS, musculoskeletal pain of shoulder, and sitting balance scores were significant predictors of the K-SCIM III total score after adjustment for demographic, SCI-related, and cognitive factors. Conclusions: Physical factors had the greatest impact on all subscores and the K-SCIM III total score. Upper- and lower-extremity muscle strength and sitting balance significantly affected functional ability across all subscores. [ABSTRACT FROM AUTHOR]

Nerve transfer after spinal cord injury has become increasingly popular. Accurate preoperative identification of lower motor neuron involvement in potential recipient nerves is critical. Electrodiagnostic testing has been shown to correlate with intraoperative findings; however, it is time-consuming, costly and may not be readily available. Stimulated manual muscle testing is an alternative diagnostic approach. It is inexpensive and easily done by the surgeon or therapist in the office; however, correlation with intraoperative stimulation has not been reported. A retrospective review was conducted for patients who underwent nerve transfer for tetraplegia with recorded preoperative stimulated manual muscle testing and intraoperative stimulation results. Nine patients including 37 nerve transfers were included. Of the 37 nerve transfers, 36 were accurately graded preoperatively by stimulated manual muscle testing. Stimulated manual muscle testing had a sensitivity of 89%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 97%. This study supports stimulated manual muscle testing for preoperative distinction between upper versus lower motor neuron injuries. Level of evidence: IV [ABSTRACT FROM AUTHOR]

This Joel A. DeLisa Lecture on endovascular brain-computer interfaces was presented by Dr Thomas Oxley on February 23, 2023, at the Association of Academic Physiatrists Annual Scientific Meeting. The lecture described how brain-computer interfaces replace lost physiological function to enable direct communication between the brain and external digital devices, such as computers, smartphones, and robotic limbs. Specifically, the potential of a novel endovascular brain-computer interface technology was discussed. The brain-computer interface uses a stent-electrode array delivered via the jugular vein and is permanently implanted in a vein adjacent to the motor cortex. In a first-in-human clinical trial, participants with upper limb paralysiswho received the endovascular brain-computer interface could use the system independently and at home to operate laptop computers for various instrumental activities of daily living. A Food and Drug Administration-approved trial of the endovascular brain-computer interface in the United States is in progress. Future development of the system will provide recipients with continuous autonomy through digital access with minimal caregiver assistance. Physiatrists and occupational therapists will have a vital role in helping people with paralysis achieve the potential of implantable brain-computer interfaces. [ABSTRACT FROM AUTHOR]

BACKGROUND: An individual experiencing tetraplegia faces functional limitations due to impaired hand function. The use of an affordable tenodesis wrist-hand orthosis (WHO) can enable finger flexion with active wrist extension, thereby enhancing the three-jaw chuck grasp and overall hand functionality. OBJECTIVES: To assess hand function and satisfaction in patients with tetraplegia using a modified tenodesis wrist-hand orthosis (WHO), utilizing the Duruöz Hand Index (DHI) and the Orthotics and Prosthetics User Survey (OPUS) satisfaction with device and services subscales. METHODOLOGY: The study was conducted at a tertiary care center in central India, enrolling patients with tetraplegia admitted to the Department of Physical Medicine and Rehabilitation. A modified tenodesis wrist-hand orthosis (WHO) was designed using low-temperature thermoplastic components. Twenty-two individuals with a minimum wrist extensor power of grade 3/5 were included in the study. These patients were provided with the modified tenodesis WHO and underwent daily training sessions for a period of 2 weeks. Duruöz Hand Index (DHI) scores were assessed at baseline, 6 weeks, and 12 weeks post-enrolment. Patient satisfaction was evaluated using the Orthotics and Prosthetics User’s Survey (OPUS) satisfaction with device and services subscales. FINDINGS: The analysis of the DHI scores indicated a significant enhancement in functional abilities at both 6-week and 12-week follow-ups compared to the baseline assessment. Notably, the most substantial progress at 6 weeks follow-up was observed in tasks such as buttoning a shirt, while significant improvement at the 12-week mark was noted in activities like turning a key in a lock. The median OPUS device satisfaction score was 50, corresponding to a Rasch score of 68.8. Additionally, the median OPUS satisfaction score for services stood at 46, with a Rasch score of 72.7. Patients expressed the highest satisfaction levels with the courteous demeanor of the staff, prompt scheduling of appointments, and accurate fitting of the orthosis. CONCLUSION: The study findings indicate that the modified tenodesis WHO is an effective and satisfactory therapeutic device for improving hand function in patients with tetraplegia. The findings encourage further investigation and application of the modified tenodesis WHO in clinical practice. Layman's Abstract Individuals who are affected due to spinal cord injury (SCI) are often unable to perform the basic daily activities of life due to weakness. The hands are one of the most specialized parts of the human body and loss of its function can be incapacitating. Certain wrist hand orthoses (WHO) can aid such individuals by assisting the weak hand muscles. One such WHO is a tenodesis wrist hand orthosis. Modifications to the previously available tenodesis wrist hand orthosis were made to make it cheaper, lighter, and easier to manufacture. The effectiveness of this modified tenodesis WHO on improving hand activity and satisfaction in the individuals using it was assessed in this study which was conducted in a tertiary care center in central India. Twenty-two individuals with cervical SCI, who had some ability to extend their wrists against gravity, were admitted to the Physical Medicine and Rehabilitation department and enrolled in this study. Notable improvements were observed in functional tasks such as buttoning a shirt, opening a lock, eating with a fork, brushing teeth, and writing, with considerable satisfaction in those trained with the modified tenodesis WHO. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/42879/33253 How To Cite: Sonune S.P, Saha A, Joshi N.G, Pathak S, Bhadra P, Goel G. The effect of a modified tenodesis wrist-hand orthosis on hand function in patients with tetraplegia. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.8. https://doi.org/10.33137/cpoj.v7i1.42879 Corresponding Author: Dr. Anyesha Saha, Affiliation: Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Saket Nagar, Bhopal (M.P.), India. E-Mails: saha.anyesha@gmail.com; anyesha.sr2023@aiimsbhopal.edu.in ORCID ID: https://orcid.org/0009-0004-1574-0519

ObjectiveSpinal cord injury (SCI) is a serious condition that can lead to partial or complete paraplegia or tetraplegia. Currently, there are few therapeutic options for these conditions, which are mainly directed toward the acute phase, such as surgical intervention and high-dose steroid administration. Mesenchymal stromal cells (MSC) have been shown to improve neurological function following spinal cord injury. The aim of the study was to evaluate the safety, feasibility, and potential efficacy of MSC transplantation in patients with cervical traumatic SCI.MethodsWe included seven subjects with chronic traumatic SCI (> 1 year) at the cervical level, classified as American Spinal Cord Injury Association impairment scale (AIS) grade A. Subjects received two doses of autologous bone marrow derived MSC, the first by direct injection into the lesion site after hemilaminectomy and the second three months later by intrathecal injection. Neurologic evaluation, spinal magnetic resonance imaging (MRI), urodynamics, and life quality questionnaires were assessed before and after treatment.ResultsCell transplantation was safe without severe or moderate adverse effects, and the procedures were well tolerated. Neurological evaluation revealed discrete improvements in sensitivity below the lesion level, following treatment. Five subjects showed some degree of bilateral sensory improvement for both superficial and deep mechanical stimuli compared to the pretreatment profile. No significant alterations in bladder function were observed during this study.ConclusionTransplantation of autologous MSC in patients with chronic cervical SCI is a safe and feasible procedure. Further studies are required to confirm the efficacy of this therapeutic approach.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT02574572, identifier NCT02574572.

Two medium-sized, 7-year-old dogs, with no previous history of pain, presented with acute neurologic symptoms consistent with intervertebral disk disease. Both cases had CT, where cervical pathology was identified. In one dog, the diagnosis was singular extensive cervical disk herniation with possible epidural hemorrhage and in the other, the diagnosis was multiple-site cervical disk herniation. The first dog, a Shar-Pei, underwent treatment with two standard adjacent ventral slots between the C4-C5 and C5-C6 intervertebral disk spaces and a fenestration between the C3 and C4 intervertebral disk spaces. The second case, a beagle, underwent a double adjacent standard ventral slot between the C5-C6 and C6-C7 intervertebral disk spaces. Both dogs recovered uneventfully after the surgery and showed no signs of recurrence during a 2-year follow-up period. This is the first detailed report of the use of a double adjacent ventral slot as a treatment for spinal decompression in medium-sized dogs with multiple-site spinal cord compression. [ABSTRACT FROM AUTHOR]

• This study investigated the cortical silent period (CSP) characteristics in stronger biceps (power = 3–5) and weaker triceps (power = 1–3) after SCI. • The CSP from the biceps had a longer duration, whereas it was delayed and shallow for the triceps in individuals with SCI. • The CSP characteristics were associated with upper arm functional ability supporting their relevance for motor recovery after SCI. Corticospinal inhibitory mechanisms are relevant to functional recovery but remain poorly understood after spinal cord injury (SCI). Post-injury characteristics of contralateral silent period (CSP), a measure of corticospinal inhibition evaluated using transcranial magnetic stimulation (TMS), is inconsistent in literature. We envisioned that investigating CSP across muscles with varying degrees of weakness may be a reasonable approach to resolve inconsistencies and elucidate the relevance of corticospinal inhibition for upper extremity function following SCI. We studied 27 adults with chronic C1-C8 SCI (age 48.8 ± 16.1 years, 3 females) and 16 able-bodied participants (age 33.2 ± 11.8 years, 9 females). CSP characteristics were assessed across biceps (muscle power = 3–5) and triceps (muscle power = 1–3) representing stronger and weaker muscles, respectively. We assessed functional abilities using the Capabilities of the Upper Extremity Test (CUE-T). Participants with chronic SCI had prolonged CSPs for biceps but delayed and diminished CSPs for triceps compared to able-bodied participants. Early-onset CSPs for biceps and longer, deeper CSPs for triceps correlated with better CUE-T scores. Corticospinal inhibition is pronounced for stronger biceps but diminished for weaker triceps muscle in SCI indicating innervation relative to the level of injury matters in the study of CSP. Nevertheless, corticospinal inhibition or CSP holds relevance for upper extremity function following SCI. [ABSTRACT FROM AUTHOR]

This qualitative study explored perceived barriers and facilitators to access and utilization of assistive technology (AT) among Veterans and civilians living with tetraplegia. We also explored differences in access to and utilization of AT between civilians and Veterans. Semi-structured focus groups were conducted with 32 adults (15 Veterans, 17 non-Veterans) living with tetraplegia between the ages of 18 and 65 and who were at least one-year post-injury. Focus groups were conducted at two rehabilitation sites: Craig Hospital and the Louis Stokes Cleveland VA Medical Center. Participants were asked to discuss what they perceive as (1) the facilitators and barriers of AT access and utilization, and (2) the value of AT use in everyday living. Data were analyzed using thematic analysis of verbatim transcripts. Facilitators of AT utilization and access included being connected to resources, trial-and-error, and knowledge gained from peers. Barriers to AT use included cost of devices, a general lack of awareness of resources, and requirements for eligibility; the latter two themes were endorsed solely by Veteran participants. Benefits of AT included increased independence, participation, productivity, quality of life, and safety. Findings highlight key facilitators of AT procurement and use, barriers that contribute to underutilization of AT, and important benefits experienced as a result of using AT that underscore the importance of AT for individuals with SCI. The need to maintain connections with rehabilitation resources (e.g., the Department of Vocational Rehabilitation, occupational and physical therapists, the VA, inpatient facilities) is vital to learning about and procuring AT. There is a need for a tailored approach to address AT underutilization in civilian and Veteran populations. Despite the barriers to AT use and the challenges associated with discovery of AT, utilization of AT may lead to increased independence, participation, productivity, quality of life, and safety. [ABSTRACT FROM AUTHOR]

• The median time until the first pneumonia event after spinal cord injury is 6 days. • Persons with traumatic AIS A, B, or C tetraplegia are at highest risk for pneumonia. • Elderly people are at increased risk for multiple pneumonia events. To describe the occurrence of pneumonia in individuals with acute spinal cord injury (SCI) and identify its key predictors. Multi-centric, longitudinal cohort study. 10 specialized SCI rehabilitation units in Europe and Australia. Eligible were 902 men and women with acute SCI, aged 18 years or older, with cervical or thoracic lesions and not dependent on 24-hour mechanical ventilation; 503 participated in the study (N=503). Not applicable. We assessed demographics and lesion related parameters at study entry, and any pneumonia events throughout inpatient rehabilitation. Respiratory function, decubitus, and urinary tract infections were assessed at 1, 3, and 6 months post injury as well as at discharge from inpatient rehabilitation. Time to event (pneumonia) analyses were done using the Kaplan-Meier method, and potential predictors for pneumonia were analyzed with multivariable survival models. Five hundred three patients with SCI were included, with 70 experiencing at least 1 pneumonia event. 11 participants experienced 2 or more events during inpatient rehabilitation. Most events occurred very early after injury, with a median of 6 days. Pneumonia risk was associated with tetraplegia (hazard ratio [HR]=1.78; 95% confidence interval [CI] 1.00-3.17) and traumatic etiology (HR=3.75; 95% CI 1.30-10.8) American Spinal Injury Impairment Scale (AIS) A (HR=5.30; 95% CI 2.28-12.31), B (HR=4.38; 95% CI 1.77-10.83), or C (HR=4.09; 95% CI 1.71-9.81) lesions. For every 10 cmH 2 O increase in inspiratory muscle strength, pneumonia risk was reduced by 13% (HR=0.87; 95% CI 0.78-0.97). Pneumonia is a major complication after SCI with the highest incidence very early after injury. Individuals with traumatic or AIS A, B, or C tetraplegia are at highest risk for pneumonia. [ABSTRACT FROM AUTHOR]

This article summarizes a study on heart rate variability (HRV) in newly injured traumatic cervical spinal cord injury (SCI) patients. The study found that the ratio of low to high frequency power was lower in patients with AIS grade B compared to AIS grade A patients, and this ratio was negatively correlated with the duration since injury. However, HRV did not vary with age or the level of cervical lesion. The findings provide insights into the factors that affect HRV in newly injured cervical SCI patients. The article does not disclose any conflicts of interest or external sources of support. [Extracted from the article]

Objective: To explore independence, usability, and self-reported quality of life (QOL) in eligible persons with spinal cord injury (SCI) who used a standing powered wheelchair over a 12-week period. Setting: VA SCI research facility. Participants: Four participants with chronic SCI who use a wheelchair as the primary means of mobility. Intervention: A standing power wheelchair was used three times a week (3.5 h/session) for 12 weeks in a supervised setting. Main Outcome Measures: safety, usability and feasibility, blood pressure in seated and standing positions, bowel, bladder, and pain item banks from the SCI-QOL Physical-Medical- Health domain, and overall user satisfaction with the device. Results: Participants consistently maintained normal blood pressure responses between seated and standing positions throughout the training sessions and learned to perform all the mobility tasks safely and independently. Participants reported improvements on the SCI-QOL and were generally satisfied with the upright standing power wheelchair. Conclusions: In this small case series of chronic, non-ambulatory individuals with SCI, the standing powered wheelchair was shown to be safe and efficacious. [ABSTRACT FROM AUTHOR]

Purpose : Trauma to the lower cervical spine is a serious lesion due to its neurological consequences which jeopardize the vital and functional prognosis. They constitute a public health problem due to their frequency and seriousness requiring rapid and adequate treatment. The aim of our study is to (1) describe the epidemiological, clinical, and radiological characteristics of lower cervical spine trauma patients; (2) support the therapeutic management of these patients and show our experience in surgery for lower cervical spine trauma; and (3) analyze the anatomical and functional results and discuss them with literature data. Methods: This is a retrospective descriptive study of 50 patients with lower cervical spine trauma treated surgically over a period of five years from January 1, 2016, to December 2020. Results: The average age of our patients was 34.5 years, with a sex ratio of 1.7. The etiologies are dominated by accidents on public roads (58%). They show neurological disorders such as spinal cord damage in 30% of cases and root damage in 20% of cases. The radiological assessment revealed eight tear drops, ten comminuted fractures, 12 severe sprains, 12 biarticular dislocations, six uniarticular dislocations, and two herniated discs. Treatment was surgical in all patients with an anterolateral approach and anterior arthrodesis. The evolution was favourable in 21 patients and stationary in 29 patients. Conclusion: Our study concluded that dislocations and fracture dislocations were the predominant type of injury in cases of AVP. Tetraplegia was mainly observed with uni- and biarticular dislocations. The variation in consolidation time was not correlated with trauma-to-surgery time. Better neurological recovery was observed with mild initial neurological damage than with initially severe damage. The appearance of an adjacent syndrome is less frequent with monosegmental arthrodesis than with multisegmental arthrodesis. Cage arthrodesis was an alternative to iliac harvesting with similar results. [ABSTRACT FROM AUTHOR]

Background: Sweat and thermal responses in individuals with spinal cord injury (SCI) are impaired depending on lesion characteristics. This is particularly problematic for athletes and may ultimately lead to reduced performance. This exploratory study investigated the feasibility of field-usable methods to objectively collect data relevant to sweat response in elite athletes with SCI. Differences in sweat response were also evaluated for different athlete characteristics. Methods: Measurements were performed during exercise and included core temperature (Tc), heart rate, urine specific gravity, fluid intake, sweat rate, and sweat electrolyte concentration. Differences for sex, lesion level (tetraplegia versus paraplegia), motor impairment (complete versus incomplete), and sport type (endurance versus team/skill) were evaluated. Results: Fifteen athletes (median (Q1–Q3) age, 30 (28–36) years; three females; 11 with complete lesions) were included. Endurance athletes were measured during indoor performance tests (n = 10), whereas team/skill athletes were measured during training sessions (n = 5). In the mixed exercise intensities, the average Tc was 37.7 (37.3–37.8) °C and the average heart rate was 126 (100–146) bpm. Dehydration, defined as a urine specific gravity > 1.020 ng/mL, was prevalent in six athletes before exercise and in five athletes after exercise. The sweat rate was lower in athletes with tetraplegia (p = 0.02) and in team/skill athletes (p = 0.008). Conclusions: Collecting sweat and thermal response data from athletes with SCI in the field is feasible. Given the suboptimal hydration status of many athletes, raising awareness of the importance of hydration seems valuable. [ABSTRACT FROM AUTHOR]

(1) Background: The influence of robotic therapy on patients with sub-acute cervical spinal cord injury (SCI) for improving their activities of daily living (ADL) performance is unclear; (2) Methods: 31 subjects with cervical SCI completed the training randomly assigned to an intervention or control group during 40 sessions. All the subjects received, in each session, 30 min of upper-extremity conventional therapy. In addition, the subjects within the control group received another 30 min of conventional therapy, whereas subjects within the intervention group received 30 min of robotic therapy with Armeo Spring (Hocoma AG, Volketswil, Switzerland). Therefore, the ADL of drinking was trained by using the exoskeleton. Feasibility and efficacy measurements as clinical scales and kinematic indices, and usability questionnaires, were used as assessment at baseline and at the ending of the study (week 10); (3) Results: The intervention group significantly improved with regards to the feeding and grooming items of the Spinal Cord Independence Measure scale. The improvement in the movement smoothness related to the activity of drinking was greater in the intervention group than in the control (p = 0.034); (4) Conclusions: The findings of this study reveal that patients with cervical SCI improve their performance in ADL with robotic therapy.

This study addresses the need for highly sensitive tools to evaluate hand strength, particularly grasp and pinch strength, which are vital for diagnosing and rehabilitating conditions affecting hand function. Current devices like the Jamar dynamometer and Martin Vigorimeter, although reliable, fail to measure extremely low force or pressure values required for individuals with severe hand impairments. This research introduces a novel device, a modified Martin Vigorimeter, utilizing an ultra-soft latex chamber and differential pressure measurement to detect minute pressure changes, thus significantly enhancing sensitivity. The device offers a cost-effective solution, making advanced hand strength evaluation more accessible for clinical and research applications. Future research should validate its accuracy across diverse populations and settings, exploring its broader implications for hand rehabilitation and occupational health.

A 65-year-old with a history of spinal cord injury and previous cervical surgery presented with persistent fever despite antibiotic treatment. MRI scans revealed an abscess in the neck extending from C3 to C6, with associated osteomyelitis. After an initial discharge following antibiotic therapy, the patient was readmitted due to recurrent systemic infection symptoms and another abscess. A subsequent endoscopy showed esophageal rupture with protruding cervical fusion metal. Due to operative risks, a percutaneous endoscopic gastrostomy was performed without further infection recurrence. The absence of typical imaging signs of esophageal rupture made diagnosis difficult. The infection spread through the cervical fascia from superficial to deep cervical areas. Esophageal rupture, a rare complication of cervical surgery, presents with varying symptoms depending on its location and was particularly challenging to diagnose in this patient due to high cervical tetraplegia, which masked typical pain responses. Therefore, this case highlights the need to consider esophageal rupture in differential diagnoses for chronic ACDF patients, even when typical symptoms are absent. [ABSTRACT FROM AUTHOR]

Regaining greater independence in performing daily activities constitutes a priority for people with tetraplegia following spinal cord injury (SCI). The highest expectations are connected with the improvement of hand function. Therefore, it is so important for the clinician to identify reliable and commonly applicable prognostic factors for functional improvement. The aim of this study was to conduct an analysis to assess the impact of initial functional factors on the clinical improvement in patients during early neurological rehabilitation (ENR). This study assessed 38 patients with complete SCI aged 17–78 who underwent ENR in 2012–2022. The analysis included the motor score from the AIS (MS), the Barthel Index (BI) and the SCIM scale values at the beginning of the ENR program and after its completion. During ENR, patients achieved a statistically significant improvement in MS, BI and SCIM. The initial MS and the level of neurological injury constituted the predictors of functional improvement during ENR. Significant statistical relationships were observed primarily in the correlations between the initial MS and BI, and the increase in the analyzed functional scales of SCI patients. Higher initial MS may increase the chances of a greater and faster functional improvement during ENR. [ABSTRACT FROM AUTHOR]

Despite continuous efforts to promote accessibility, a pressing need remains for increased focus on digital access, particularly for individuals with upper limb mobility limitations, to ensure full integration into computer usage. In response to this challenge, the university extension project Assistive and Adaptive Peripherals (ASAP) was established to leverage 3D printing technology to enhance digital accessibility. This research aimed to construct a conceptual prototype for an assistive mouse and keyboard using readily available and accessible materials, emphasizing the potential for widespread replication. Beyond this immediate goal, the secondary objective was to initiate the extension of the project, focusing on the development of assistive computer peripherals to foster social inclusion. Volunteer participation, including interviews with individuals with limb impairments such as tetraplegia, during the testing phase added a valuable human-centered design (HCD) perspective to the study. This approach ensured that the end-users' needs and preferences were at the core of the design process, making the resulting products more practical and user-friendly. Additionally, a thorough literature review on digital accessibility products was conducted. Through these methodological stages, the research yielded valuable insights, identifying theoretical and technological factors crucial for future applications of the ASAP project. This includes refining the research methodology and advancing the maturity levels of future devices. Looking ahead, the ASAP project will continue its extension activities by developing new assistive peripherals based on the findings of this study. [ABSTRACT FROM AUTHOR]

Copyright of Romanian Journal of Veterinary Orthopedics & Imagistic is the property of Innovation in Health Center and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: The aims of the study are to determine the cardiovascular risk burden rehabilitation discharge and to explore the association between recovery during rehabilitation and cardiovascular disease risk profile. Methods: We included adults without cardiovascular disease admitted for rehabilitation. We evaluated rehabilitation outcomes on admission and discharge. Cardiovascular disease risk profile was assessed by Framingham risk score, high-density lipoprotein, and fasting glucose level. Results: We analyzed data from 706 participants (69.6% men) with a median age of 53.5 yrs. The median time since injury was 14 days, and the admission length was 5.2 months. Majority had paraplegia (53.3%) and motor incomplete injury (53.7%). One third of the cohort had high cardiovascular risk profile before discharge. At discharge, poorer anthropometric measures were associated with higher Framingham risk score and lower high-density lipoprotein levels. Individuals with higher forced vital capacity (>2.72 l) and peak expiratory flow (>3.4 l/min) had 0.16 mmol/l and 0.14 mmol/l higher high-density lipoprotein compared with those with lower respiratory function, respectively. Individuals with higher mobility score (>12.5) and functional independence score (>74) had 0.21 and 0.18 mmol/l higher high-density lipoprotein compared with those with lower scores. Conclusions: There is high cardiometabolic syndrome burden and cardiovascular disease risk profile upon rehabilitation discharge. Higher respiratory function, mobility, and overall independence were associated with better cardiovascular disease risk profile, although with study design limitations and short follow-up. Future studies should explore whether rehabilitation outcomes could be used to prioritize screening. [ABSTRACT FROM AUTHOR]

Background. Lesions of the vertebral artery (VA) may develop spontaneously or as a result of severe traumatic cervico-cephalic injuries. Most frequent VA injuries (VAI) result from blunt trauma to the spine or may be due to penetrating lesions. VAI plays a significant role in the broader context of cervical spine trauma by providing insights into the vascular aspects of spinal cord injury (SCI). Upper cervical spine fractures and accompanying subluxation, as well as transverse process fractures extending into the artery bone foramen, are associated with an elevated risk of VAI. Clinical case. A 63-year-old female patient with flaccid C4 AIS-A quadriplegia (global motor score 3/100), vertebral myelopathy, neurogenic bladder, sacral pressure sore, and blindness was transferred from the spinal neurosurgical department. The patient fell from the same level and suffered a mild brain concussion and, apparently, a minor cervical SCI on October 1, 2022. She was asymptomatic, then quickly became tetraplegic, and then blindness added on in a few days. She was operated on on October 7, 2022, for a C6 vertebral body fracture and a C5-6 dislocation. The surgical protocol consisted of anterior spinal cord decompression, dislocation reduction, and mixed anterior fusion with bone grafts and fixation screws. Following the traumatic event, a bilateral posterior cerebral artery (PCA) stroke subsequently produced blindness and partial optic atrophy in both eyes. Serial clinical and imaging examinations confirmed the diagnosis: a subacute bilateral occipital stroke and a chronic lacunar lesion in the right thalamus associated with a severe spinal cord lesion. Anticoagulation has partially improved the neurological outcomes of stroke in the PCA territory. Ethical considerations. The patient's next of kin has given written consent to the case study and to use the radiological images related to the case for academic purposes. The personal identity data was anonymized. The presentation of this clinical case has the approval of the ethics commission of TEHBA (no. 40205/01.09.2023). Discussion. The clinical example is notable for the concurrent development of two severely devastating neurological syndromes, quadriplegia, and blindness, which occurred after an initially minor cervical trauma and progressed gradually Careful clinical and imaging monitoring through detailed serial imaging procedures must be performed for every person with severe cranio-cervical trauma. The clinical example emphasizes the importance of the interprofessional team's participation in the patient's care.over a few days. VA lesions after cervical trauma are considered rare, and the diagnosis is difficult because the vast majority of individuals do not exhibit cerebral neurological symptoms (due to the collateral compensatory blood supply from the circle of Willis). Most of the patients with bilateral or dominant VA occlusions are symptomatic, with rapid (and possibly fatal) ischemic damage to the encephalon, cerebellum, or brainstem. The detection and tracking of evolutionary tendencies required a series of clinical tests, including fundoscopy, and imaging procedures, including native CT, MRI, and MR angiography scans of the brain and spine. Conclusions. Although VAI is a rare complication, in every polytrauma patient with head and neck trauma, VA damage should be suspected. [ABSTRACT FROM AUTHOR]

Spinal cord injury is a serious injury that can result in a series of complications that will impact the injured individual and their families. One of these complications is bowel dysfunction. The individual with spinal cord injury could have a total loss of bowel function and control post-injury, which can result in pain and discomfort. Establishing a safe and sustainable bowel programme is essential to controlling bowel movement and improving overall quality of life. The aims of this article are to provide healthcare professionals with an understanding of the impact of spinal cord injury on bowel function and to help establish a successful bowel programme for patients. In particular, how spinal cord injury affects and impacts bowel control; establishing goals of a bowel management programme for individuals; reviewing factors involved in establishing a successful bowel management regimen following spinal cord injury. [ABSTRACT FROM AUTHOR]

(1) Improving upper limb function is essential for people with tetraplegia. Although promising, technology-assisted upper limb training is understudied in this population. This article describes its implementation in a Swiss spinal cord injury rehabilitation centre and reports on the observed changes. (2) A retrospective evaluation of clinical data from January 2018 to June 2020 examined patient characteristics, training parameters, goal-setting practices, goal achievement, and changes in muscle strength over the course of technology-assisted upper limb training. (3) Data analysis included 61 individuals, 68.9% of whom had a spinal cord injury. The ArmeoSpring was the most frequently used device. The typical treatment regimen was three 25 min sessions per week, with evaluations approximately every six weeks. The 1:1 sessions, delivered by specialised staff, focused primarily on improving shoulder movement and the ability to eat and drink. Functional goals were set using a grid. Performance on selected goals in the areas of 'body functions' and 'activities & participation' as well as muscle strength, increased over the course of training. (4) The ArmeoSpring has broad applicability. Despite the observed improvements, the isolated effect of technology-assisted upper limb training cannot be concluded due to the lack of a control group and various concurrent interventions. [ABSTRACT FROM AUTHOR]

Despite continuous efforts to promote accessibility, a pressing need remains for increased focus on digital access, particularly for individuals with upper limb mobility limitations, to ensure full integration into computer usage. In response to this challenge, the university extension project Assistive and Adaptive Peripherals (ASAP) was established to leverage 3D printing technology to enhance digital accessibility. This research aimed to construct a conceptual prototype for an assistive mouse and keyboard using readily available and accessible materials, emphasizing the potential for widespread replication. Beyond this immediate goal, the secondary objective was to initiate the extension of the project, focusing on the development of assistive computer peripherals to foster social inclusion. Volunteer participation, including interviews with individuals with limb impairments such as tetraplegia, during the testing phase added a valuable human-centered design (HCD) perspective to the study. This approach ensured that the end-users' needs and preferences were at the core of the design process, making the resulting products more practical and user-friendly. Additionally, a thorough literature review on digital accessibility products was conducted. Through these methodological stages, the research yielded valuable insights, identifying theoretical and technological factors crucial for future applications of the ASAP project. This includes refining the research methodology and advancing the maturity levels of future devices. Looking ahead, the ASAP project will continue its extension activities by developing new assistive peripherals based on the findings of this study. Keywords: Assistive Technology; 3D Printing; Tetraplegia; Inclusive Design; Computer Peripheral Melhorando o acesso ao computador para indivíduos com deficiência de membro superior através de ações extensionistas Resumo: Apesar dos esforços contínuos para promover a acessibilidade, ainda existe a necessidade de maior foco no acesso digital, especialmente para indivíduos com limitações de mobilidade nos membros superiores, a fim de garantir a integração total na utilização do computador. Em resposta a este desafio, foi criado o projeto de extensão universitária Assistive and Adaptive Peripherals (ASAP), com o objetivo de utilizar a tecnologia de impressão 3D para melhorar a acessibilidade digital. Esta pesquisa teve como objetivo construir um protótipo conceitual para mouse e teclado assistencial utilizando materiais prontamente disponíveis e acessíveis, enfatizando o potencial de replicação generalizada. Para além deste objetivo imediato, o objetivo secundário é iniciar o projeto de extensão ASAP, centrando-se no desenvolvimento de periféricos informáticos auxiliares para promover a inclusão social. A participação de voluntários, incluindo entrevistas com indivíduos com deficiências nos membros superiores, como tetraplegia, durante a fase de testes adicionou uma valiosa perspectiva de design centrado no ser humano (HCD) ao estudo. A metodologia foi enraizada no HCD, colocando o usuário final no centro do processo de design para o desenvolvimento de produtos e serviços de saúde. Além disso, foi realizada uma revisão da literatura sobre produtos de acessibilidade digital. Através destas etapas, a pesquisa rendeu insights valiosos, identificando fatores teóricos e tecnológicos cruciais para futuras aplicações do projeto ASAP. Olhando para o futuro, o projeto ASAP continuará as suas atividades de extensão através do desenvolvimento de novos periféricos de assistência com base nas conclusões deste estudo. Palavras-chave: Tecnologia Assistiva; Impressão 3D; Tetraplegia; Design Inclusivo; Periférico De Computador

Two medium-sized, 7-year-old dogs, with no previous history of pain, presented with acute neurologic symptoms consistent with intervertebral disk disease. Both cases had CT, where cervical pathology was identified. In one dog, the diagnosis was singular extensive cervical disk herniation with possible epidural hemorrhage and in the other, the diagnosis was multiple-site cervical disk herniation. The first dog, a Shar-Pei, underwent treatment with two standard adjacent ventral slots between the C4–C5 and C5–C6 intervertebral disk spaces and a fenestration between the C3 and C4 intervertebral disk spaces. The second case, a beagle, underwent a double adjacent standard ventral slot between the C5–C6 and C6–C7 intervertebral disk spaces. Both dogs recovered uneventfully after the surgery and showed no signs of recurrence during a 2-year follow-up period. This is the first detailed report of the use of a double adjacent ventral slot as a treatment for spinal decompression in medium-sized dogs with multiple-site spinal cord compression.

Objective: To investigate the association between propulsion biomechanics, including force application and spatio-temporal characteristics, and shoulder pain in persons with tetraplegia. Design: Cross-sectional, observational study. Setting: Non-university research institution. Participants: 16 community dwelling, wheelchair dependent persons with a chronic tetraplegia between C4 and C7, with and without shoulder pain (age, 49.1±11.7 years; 94% men, 23.4±9.5 years past injury). Interventions: Not applicable. Main Outcome Measures: Force application and spatio-temporal characteristics of wheelchair propulsion on a treadmill (0.56 m/s, 10W and 0.83 m/s, 15W). Participants were stratified in groups with low, moderate, and high pain based on their Wheelchair User Shoulder Pain Index (WUSPI) score on the day of measurement. Results: The mixed-effect multilevel analysis showed that wheelchair users with high levels of shoulder pain applied propulsion force more effectively (and with a lower medial component) and over a longer push angle, thus shortening the recovery time as compared with persons with low or moderate levels of shoulder pain. Conclusions: In contrast with previous results from persons with a paraplegia, persons with tetraplegia and high levels of shoulder pain propel their wheelchair more optimal with regard to risk factors for shoulder pain. Our results therefore affirm that there is a different interaction of shoulder pain and propulsion biomechanics in persons with a tetraplegia which should be considered when further analyzing risk factors for shoulder pain in wheelchair users or applying literature results to different patient populations.

Milk of calcium is a colloidal suspension of precipitated calcium salts which lies in a dependent manner and imaging reveals a horizontal upper edge. We report a 44-year-old male person with tetraplegia, who had been staying in bed for prolonged periods due to ischial and trochanteric pressure sores. Ultrasound scan of the kidneys revealed numerous variable-sized stones in the left kidney. CT of abdomen showed stones in the left kidney with dense layering of calcific material in a dependent distribution assuming the shape of the renal pelvis and the calyces. CT images in axial and corresponding sagittal views showed milk of calcium exhibiting a fluid level in the renal pelvis and calyces and the ureter. This is the first report of milk of calcium detected in the renal pelvis and calyces as well as in the ureter of a person with spinal cord injury. Following insertion of a ureteric stent, the milk of calcium in the ureter drained partly but the renal milk of calcium persisted. The renal stones were pulverized by ureteroscopy and LASER lithotripsy. Follow-up CT of kidneys performed 6 weeks after surgery showed the milk of calcium in the left ureter had drained, but there was no significant change of the left sizeable branching pelvi-calyceal stone regarding its extension and density.

Introduction Sweat response and thermoregulation in individuals with spinal cord injury (SCI) may be impaired depending on the level and completeness of the lesion (Grossmann et al., 2021; Price, 2006). This is particularly problematic for athletes and may ultimately lead to decreased performance. This exploratory observational study collected data on sweat response in elite athletes with SCI during exercise. We also explored the feasibility of collecting these data in the field. Methods: Elite athletes with SCI were measured during indoor performance tests (n = 10) or training sessions (n = 5). Parameters collected included core body temperature (Tc), heart rate, urine specific gravity, fluid intake, sweat rate, and sweat electrolyte concentration. Differences in parameters were evaluated for sex, lesion level (tetraplegia versus paraplegia), motor impairment (complete versus incomplete), and sport type (endurance versus team/skill). Results 15 athletes (median (Q1-Q3) age 30 (28-36) years, three females, 11 with a complete lesion) were included. Measurements could be successfully performed on most athletes. Average Tc was 37.7 (37.3-37.8) °C and average heart rate 126 (100-146) bpm. Dehydration, defined as a urine specific gravity > 1.020 ng/ml, was prevalent in six athletes before exercise and in five athletes after exercise. Fluid intake and electrolyte concentrations were similar between groups. Sweat rate was lower in athletes with a tetraplegia (-0.04 (-0.23-0.37) versus 0.51 (0.38-0.73) l/h, p = 0.02, r = 0.60) and in team/skill athletes (0.12 (-0.13-0.33) versus 0.52 (0.42-0.73) l/h, p = 0.008, r = 0.68). Discussion/Conclusion The measurement methods used in this study are straightforward and relatively easy to perform in the field. Our results suggest that there is room for improvement in the hydration status of elite athletes with SCI, especially prior to exercise. Optimization of fluid intake and thermoregulation requires personalized strategies based on lesion characteristics and type of sport. References Grossmann, F., Flueck, J. L., Perret, C., Meeusen, R., & Roelands, B. (2021). The thermoregulatory and thermal responses of individuals with a spinal cord injury during exercise, acclimation and by using cooling strategies – A systematic review. Frontiers in Physiology, 12, Article 636997. https://doi.org/10.3389/fphys.2021.636997 Price, M. J. (2006). Thermoregulation during exercise in individuals with spinal cord injuries. Sports Medicine, 36(10), 863-879. https://doi.org/10.2165/00007256-200636100-00005

Understanding human functioning and disablement, the contributing factors and their interactions in individuals with tetraplegia is important since elective upper extremity (UE) reconstructive surgery is now offered earlier after injury prior to full recognition of what lies ahead. Qualitative and quantitative data were available from a prior series of mixed methods studies, including a case series design capturing the patients' lived-experience perspectives of nerve or tendon transfer surgery, or not as the case may be. The objective of this study was to perform secondary data analysis to determine whether the recommended outcome tools being used by clinicians reflect the all important domains of functioning identified by people with tetraplegia who were considering UE reconstructive procedures. The original 18 candidate themes derived from qualitative analysis were reviewed in retrospect, along with a content analysis of the tools' questions, undertaking word mapping links to the ICF taxonomy. The outcomes tools included in the content analysis were the Canadian Occupational Performance Measure, the Capabilities of Upper Extremity Questionnaire, The Personal Wellbeing Index, and the Grasp and Release Test. Comparison between clinical outcomes tools and the patient lived-experience data uniquely identified links to Chapter1 (b) Mental functions, which include consciousness, orientation, temperament/personality, energy/drive, and higher-level cognition. [ABSTRACT FROM AUTHOR]

Background: Persons with tetraplegia rank improved upper extremity (UE) function as the most important rehabilitation outcome because it allows them greater independence in activities of daily living (ADL). The aim of this study was to describe UE status in patients with tetraplegia using the International Spinal Cord Injury Upper Extremity Basic Data Set version 1.1 (ISCI-UE 1.1) and to determine differences in UE status between tetraplegic individuals with traumatic and non-traumatic SCIs. Methods: This cross-sectional study was conducted among patients with tetraplegia who attended the SCI rehabilitation clinic of a tertiary hospital from September 2021 to August 2022. Both upper limbs were assessed using ISCI-UE 1.1. Results: One hundred patients were included in this study, of whom 80 were men. The mean (SD) age of the patients was 54.30 (16.95) years old. In these patients, most SCIs (62%) were of traumatic origin. Two hundred UEs were evaluated, of which 109 showed good hand function (level 5) and 10 had the poorest hand function (level 1). Meanwhile, 130 UEs showed good shoulder function (level D) and 10 had the poorest shoulder function (level A). A statistically significant association with UE status (reach-and-grasp ability and shoulder function) was found in both the non-traumatic and traumatic SCI groups, with better hand and shoulder functions in the non-traumatic SCI group (right-hand, P = 0.004 and left hand, P = 0.001; right shoulder, P < 0.001 and left shoulder, P = 0.002). Conclusion: ISCI-UE 1.1 is a feasible tool for documenting UE function in patients with tetraplegia. Compared with the individuals with traumatic SCI in this study, those with non-traumatic SCI demonstrated better upper extremity functionality. [ABSTRACT FROM AUTHOR]

• Blood pressure dysregulation is common but underdiagnosed in SCI. • Understanding the effect of blood pressure dysregulation on well-being is limited by poor measurement tools. • A new patient-reported outcome measure that captures problems with blood pressure was developed. To report on the development and calibration of the new Blood Pressure Dysregulation Measurement System (BPD-MS) item banks that assess the effect of BPD on health-related quality of life (HRQOL) and the daily activities of Veterans and non-Veterans with spinal cord injury (SCI). Cross-sectional survey study. Two Veteran Affairs medical centers and a SCI model system site. 454 respondents with SCI (n=262 American Veterans and n=192 non-Veterans; N=454). Not applicable The BPD-MS item banks. BPD item pools were developed and refined using literature reviews, qualitative data from focus groups, and cognitive debriefing of persons with SCI and professional caregivers. The item banks then underwent expert review, reading level assessment, and translatability review prior to field testing. The items pools consisted of 180 unique questions (items). Exploratory and confirmatory factor analyses, item response theory modeling, and differential item function investigations resulted in item banks that included a total of 150 items: 75 describing the effect of autonomic dysreflexia on HRQOL, 55 describing the effect of low blood pressure (LBP) on HRQOL, and 20 describing the effect of LBP on daily activities. In addition, 10-item short forms were constructed based on item response theory-derived item information values and the clinical relevance of item content. The new BPD-MS item banks and corresponding 10-item short forms were developed using established rigorous measurement development standards, which represents the first BPD-specific patient-reported outcomes measurement system unique for use in the SCI population. [ABSTRACT FROM AUTHOR]

INTRODUCTION. The prevalence of severe spine and spinal cord injuries worldwide is increasing, while the structure and nature of recovery of lost functions remain poorly understood. AIM. To study the variability of functional activities during continued rehabilitation to distinguish pure rehabilitation goals MATERIAL AND METHODS. 190 patients with C4D1 tetraplegia 1860 years old whose were under clinical and functional follow up over a period for 57 years after spinal cord injury were examined. They were examed using the motor section of the FIM scale (FIMm), the VLT scale. The rehabilitation program was standardized and based on the National Clinical Guidelines for physical rehabilitation in spinal cord injured patients. RESULTS. At admission, the age of the patients was 31 (24.0; 43.0) years, the proportion of patients with DU C4C6 was 117 (62 %), with complete damage types A and B was 134 (70 %) patients, men 151 (79 %). Functional improvement was 19 (12.0; 28.0) points on the VLT scale; 14 (5.0; 21.0) points on the FIMm scale over the entire observation period, and was predominantly noted in the first rehabilitation cycle. The proportion of patients completely independent increased on FIMm activities: eating by 25 %, dressing the upper body by 33 %, dressing the lower body by 20 %, self-care domain by +34 %, wheelchair transfer by 21 %, walking by 5 %, and the proportion of patients completely dependent decreased: eating by 9 %, upper dressing by 13 %, lower dressing by 12 %, self-care domain by 7 %, wheelchair transfer by 21 %, wheelchair mobility by 11 %, and walking by 4.5 %. Changes on the VLT scale domains were balance domain 14 %, 1 finger 18 %, hand 26 %, and manipulation 11 %. The gain in food intake activity (FIM) was higher in patients with DU C6C8 (4050 %) and incomplete motor damage (43 %), on the VLT scale domains similar to C6C8 (1218 %), and incomplete motor damage (20 %). CONCLUSION. The most significant functional recovery occurred in self-care and transfer activities, as well as hand and pinch grasping.

Background: Sweat and thermal responses in individuals with spinal cord injury (SCI) are impaired depending on lesion characteristics. This is particularly problematic for athletes and may ultimately lead to reduced performance. This exploratory study investigated the feasibility of field-usable methods to objectively collect data relevant to sweat response in elite athletes with SCI. Differences in sweat response were also evaluated for different athlete characteristics. Methods: Measurements were performed during exercise and included core temperature (Tc), heart rate, urine specific gravity, fluid intake, sweat rate, and sweat electrolyte concentration. Differences for sex, lesion level (tetraplegia versus paraplegia), motor impairment (complete versus incomplete), and sport type (endurance versus team/skill) were evaluated. Results: Fifteen athletes (median (Q1–Q3) age, 30 (28–36) years; three females; 11 with complete lesions) were included. Endurance athletes were measured during indoor performance tests (n = 10), whereas team/skill athletes were measured during training sessions (n = 5). In the mixed exercise intensities, the average Tc was 37.7 (37.3–37.8) °C and the average heart rate was 126 (100–146) bpm. Dehydration, defined as a urine specific gravity > 1.020 ng/mL, was prevalent in six athletes before exercise and in five athletes after exercise. The sweat rate was lower in athletes with tetraplegia (p = 0.02) and in team/skill athletes (p = 0.008). Conclusions: Collecting sweat and thermal response data from athletes with SCI in the field is feasible. Given the suboptimal hydration status of many athletes, raising awareness of the importance of hydration seems valuable.