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This study assessed the contributions of prior war captivity trauma, the appraisal of the current COVID-19 danger and its resemblance to the prior trauma, and long-term trajectories of posttraumatic stress disorder (PTSD) to risk for PTSD during the COVID-19 pandemic. Capitalizing on a 29-year longitudinal study with four previous assessments, two groups of Israeli veterans - ex-Prisoners-of-War (ex-POWs) of the 1973 Yom Kippur War and comparable combat veterans of the same war - were reassessed during the COVID-19 pandemic. Previous data were collected on their PTSD trajectory 18, 30, 35, and 42 years after the war and exposure to stressful life events after the war. Currently, we collected data on their PTSD during the COVID-19 pandemic and their appraisal of similarities of past trauma with the current pandemic. Previously traumatized ex-POWs were found to be more vulnerable and had significantly higher rates of PTSD and more intense PTSD during the current pandemic than comparable combat veterans. Moreover, veterans in both groups who perceived the current adversity (captivity, combat) as hindering their current coping were more likely to suffer from PTSD than veterans who perceived it as a facilitating or irrelevant experience. In addition, chronic and delayed trajectories of PTSD among ex-POWs increased the risk for PTSD during the pandemic, and lifetime PTSD mediated the effects of war captivity on PTSD during the current pandemic. These findings support the stress resolution perspective indicating that the response to previous trauma - PTSD and its trajectories - increased the risk of PTSD following subsequent exposure to stress.

Chronic pain induces a multitude of harmful effects; recently it has been suggested that chronic pain is also associated with premature aging, manifested in shortened telomere length (TL). However, evidence for this hypothesis is scarce and inconsistent. The aim was twofold: 1) Investigate whether chronic pain is associated with premature aging, and 2) Determine whether physical exercise (PE) moderates this association if it exists. Participants were 116 male subjects, with (n = 67) and without chronic pain (n = 49). Blood samples for TL analysis were collected and participants were interviewed and completed questionnaires. As a part of the cohort, we included people with physical disability; this variable was controlled in the analysis. The TL of individuals with chronic pain was significantly shorter than that of pain-free individuals. Regression analysis revealed a significant moderating effect of PE on chronic pain and TL, above and beyond the effects of disability, age, and weight. Whereas chronic pain was associated with shorter telomeres in participants who did not exercise, this association was nonsignificant among participants who did exercise. The results suggest that chronic pain is associated with premature ageing; however, PE may mitigate this association and may protect individuals against the harmful effects of chronic pain. Perspective The study suggests that it is important to monitor signs of premature ageing among chronic pain patients as they are at risk. However, chronic pain patients may benefit from regular PE in this respect as it may moderate premature ageing.

Shmuel Springer,1 Itamar Friedman,2 Avi Ohry3,4 1Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel; 2ProMedoss, Charlotte, NC, USA; 3Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 4Reuth Rehabilitation and Medical Center, Tel Aviv, Israel Background: Age-related changes in coordinated movement pattern of the thorax and pelvis may be one of the factors contributing to fall risk. This report describes the feasibility of using a new thoracopelvic assisted movement device to improve gait and balance in an elderly population with increased risk for falls. Methods: In this case series, 19 older adults were recruited from an assisted living facility. All had gait difficulties (gait speed MDC in their clinical measures after 6 treatment sessions, and more than half improved >MDC after 12 sessions. Six subjects (32%) improved their Timed Up and Go time by >4 seconds after 6 sessions, and 10 (53%) after 12 sessions. After the intervention, 4 subjects (21%) improved their 10-meter Walk Test velocity from limited community ambulation (0.4–0.8 m/s) to functional community ambulation (>0.8 m/s). Conclusion: Thoracopelvic assisted movement training that mimics normal walking pattern may have clinical implications, by improving skills that enhance balance and gait function. Additional randomized, controlled studies are required to examine the effects of this intervention on larger cohorts with a variety of subjects. Keywords: gait, balance, older adults, training

Objective This study sheds light on the importance of long-term follow-up of trauma survivors, posttraumatic stress disorder (PTSD) trajectories, and early detection of health risk factors in trauma survivors. The present study prospectively assessed the following over 23 years: (1) the association of psychological and physiologic stress during captivity with elevated C-reactive protein (CRP) levels and metabolic syndrome (MetS), which includes hypertension; elevated levels of insulin, triglycerides, and fasting glucose; decreased levels of high-density lipoprotein cholesterol; and obesity and (2) the implication of PTSD trajectories in elevated CRP levels and MetS. Methods Measurements were taken in 1991, 2003, 2008, and 2015. Participants were 116 Israeli combat veterans of the 1973 Yom Kippur War (of these, 101 were former prisoners of war [ex-POWs] and 15 were comparable controls). The medical assessments relevant for this study were body mass index, fasting blood glucose levels, and diabetes, blood pressure or a diagnosis of hypertension, high-density lipoprotein cholesterol and triglyceride levels, and medication intake. In addition, the PTSD Inventory was used to assess PTSD symptoms and trajectories over time according to DSM-IV-TR PTSD criteria. Results Captivity-in particular, the captivity stressors of weight loss, physical suffering, psychological suffering, and humiliation-was implicated in both elevated CRP levels and MetS, significantly so with elevated CRP levels (P = .01, R² = 0.33). Captivity-induced PTSD, in particular chronic and delayed PTSD trajectories, was associated with elevated CRP levels and MetS, significantly so for MetS (P = .05). Conclusions Monitoring inflammation using markers like CRP level in trauma survivors can be beneficial, particularly if PTSD is chronic or delayed. Clinicians treating trauma survivors should raise awareness of the importance of such measures in light of long-term health vulnerabilities.

Traumatic injury to the spinal cord during spinal or epidural anesthesia is usually secondary to either direct needle penetration or intra-neural injection of local anesthetics. Two women were admitted to a rehabilitation department with paraparesis and hypoesthesia after delivery. One had undergone a lower segment cesarean section under spinal anesthesia and the other, a spontaneous delivery under epidural anesthesia. After discharge from the rehabilitation treatment, they both experienced some weakness in the lower limbs. The patho-physiological basis of this complication seems to be either direct damage to the spinal cord by intra-neural injection of local anesthetics, or local ischemia.

Background. The process of a comprehensive rehabilitation of the disabled person may be more complicated when the diagnosis becomes vague and uncertain. Unknown data about the patient’s past, mental, physical or vocational background, may cast a different light on the process. The patient’s diagnosis sometimes becomes an enigma. Using the model of Venn, the patient’s situation shifts from one circle to another. The only logical solution in these cases is to use the Occam’s Razor. Purpose. To draw the attention of rehabilitation medicine professionals to the problem of clients whose diagnoses are vague and uncertain and to share with the readers my personal thoughts on this topic. Methods. Reviewing literature and sharing with the readers the author’s 43 years of clinical experience in the field of rehabilitation medicine. Results and Conclusions. A PubMed query revealed 1479 articles with the words „diagnostic enigma”. The search term „diagnostic enigma in rehabilitation medicine” resulted only in four articles. In the long process of rehabilitation of disabled patients, some patients’ diagnoses change during the hospitalization phase and some diagnoses become unclear. The rehabilitation process becomes complicated and sometimes incomplete. Implications for Rehabilitation Medicine: 1. In most instances, patients are referred to rehabilitation medicine facilities with definite diagnoses. 2. The long process of a comprehensive rehabilitation of the disabled person may be more complicated when, prior to the discharge, the final diagnosis becomes vague and uncertain. 3. Facts about the patient’s past mental, physical or vocational background may cast a different light on the process. The patient’s diagnosis sometimes becomes an enigma.

The Swiss physician Adolf Lukas Vischer described a psychiatric syndrome among prisoners of war, the ‘barbed-wire disease’ that follows a long-term incarceration and which involved boredom, confusion, clouding of consciousness and amnesia. Vischer first identified this as an important clinical issue. Later in life, he became one of the first geriatricians and gerontologists.

PurposeThe purpose of this paper is to uncover attitudes of physical therapists (PTs) who treat vegetative state (VS) patients, and to raise awareness to ethical and professional dilemmas: Are PTs influenced by ageist perceptions? Do they consider physiotherapy to be effective or futile?Design/methodology/approachEthical questions and complex dilemmas are by and large subconscious and rarely explicitly voiced, but can be identified by revealing implicit therapists' personal and professional approach to patients. A quantitative six‐point Likert scale questionnaire was developed, which presented two VS cases – young and old, followed by practical‐ethical questions concerning key issues including: treatment choices, quality of life, prolongation of life, futile treatment (n=101, 68 percent return rate).FindingsThe results reveal a complex reality: on the one hand PTs expressed a positive perception of their profession, and consider all treatment components important for VS patients and their families regardless of age; on the other hand, significant preference for treating the younger VS patient was found.Practical implicationsThere is a need for raising awareness of physiotherapists to the social phenomenon of ageism and its implications on daily professional and ethical conduct.Originality/valueWhile other studies revealed ageism in various health care settings, this study was original both in its methodology (examining implicit ageism via contrasting vignettes), and its unique context (VS patients) which in theory could be viewed as “ageless” in light of the patients' permanent condition.

Felicjan Sławoj-Składkowski was a Polish physician, General and politician who served as Polish Minister of Internal Affairs and was the last Prime Minister of Poland before the Second World War. The lack of basic sanitation in many of Poland’s villages caused him to issue a decree that every household in Poland must have a latrine in working order. Wooden sheds were built in the backyards, subsequently named ‘sławojkis’.

Electrostimulation for the treatment of pressure sores remains problematic and controversial. We studied the decubitus direct current treatment (DDCT) electrostimulation treatment of pressure sores stage 3 degree, with respect to rates of ulcer closure and wound area reduction. This was a multicenter, double-blind, randomized, placebo-controlled study involving 11 departments of geriatric and rehabilitation medicine including 63 patients. We compared a placebo treated group (PG) with an active treatment group (TG). Treatment lasted for 8 consecutive weeks, followed by a 12-week-period of follow-up. At day 57 (end of treatment) and at day 147 (end of follow-up), there was no difference between the groups with regards to rates of complete closure of ulcers (p=0.28 and 0.39, respectively), as well as for the mean time needed to achieve complete wound closure (p=0.16). Absolute ulcer area reduction and speed rate of wound area reduction (reflected by change from baseline ulcer area, percentage) were better in participants allocated in the treatment group only until day 45 (standardized estimate for trend of healing speed -0.44 and -0.14 for TG and PG, respectively). Afterwards, there were no differences between the two groups. A logistic regression analysis favored complete healing in TG, compared with PG (odds ratio 1.6, CI 0.4-4.73). Analysis of per protocol patients revealed that time needed for wound closure was 52% longer in PG (p=0.03, compared with TG). The results suggest that DDCT treatment for pressure ulcers grade 3 degree, in addition to the conservative wound care, may be useful in accelerating the healing process during the first period of care.

Objectives: To test if a combined stimulation-training program can improve selected hand functions and impairments of chronic stroke survivors. Design: Pretest-Posttest, multi-site 5-week training program. Stroke survivors ( N =7 7) with chronic upper limb paresis completed a home-based stimulation program combining activation of the wrist-fingers flexors and extensors with functional grasp, hold and release training. Subjects trained 2-3 times each day, 7 days a week. Outcome measures included: the Jebsen-Taylor simulated feeding (S-feed); light object lift (J-T light); heavy object lift (J-T heavy); Box and Blocks test (BB Nine-Hole Peg (9-HP); Ashworth scale (Spasticity); Visual analog scale-VAS (Pain). Paired t-tests ( α< 0.01) were performed on each study outcome. Results: Simulated feeding time decreased from 39.1 ± 30.9 sec to 25.5 ± 23.3 sec (34.8% improvement). The task time of the J-T light decreased by 13.3 sec and the J-T heavy by 11.5 sec (44.9% and 40.9% improvement respectively). The number of blocks moved increased from 19.4 ± 11.6 to 24.5 ± 12.5 (26.3% improvement) and the time to complete the 9-HP decreased from 178.8 ± 170.8 to 105.0 ± 117.1 sec (58.7% improvement). Mean reduction of spasticity was 0.87 and 0.78 points at the elbow and wrist respectively. Patients with persistent pain ( N =3 3) reported mean reduction from 3.5 ± 2.5 to 1.9 ± 1.8. Conclusions: Five weeks of daily home training with a task-specific stimulation program improved selected hand functions and upper limb impairments associated with chronic post-stroke paresis.

We describe two patients who developed a severe spinal cord damage long time after cessation of irradiation therapy. The various and unique rehabilitation medicine aspects are discussed and the literature is surveyed.

The pathophysiology of the chronic pain following spinal cord injury (SCI) is unclear. In order to study it's underlying mechanism we characterized the neurological profile of SCI subjects with (SCIP) and without (SCINP) chronic pain. Characterization comprised of thermal threshold testing for warmth, cold and heat pain and tactile sensibility testing of touch, graphesthesia and identification of speed of movement of touch stimuli on the skin. In addition, spontaneously painful areas were mapped in SCIP and evoked pathological pain--allodynia, hyperpathia and wind-up pain evaluated for both groups. Both SCIP and SCINP showed similar reductions in both thermal and tactile sensations. In both groups thermal sensations were significantly more impaired than tactile sensations. Chronic pain was present only in skin areas below the lesion with impaired or absent temperature and heat-pain sensibilities. Conversely, all the thermally impaired skin areas in SCIP were painful while painfree areas in the same subjects were normal. In contrast, chronic pain could be found in skin areas without any impairment in tactile sensibilities. Allodynia could only be elicited in SCIP and a significantly higher incidence of pathologically evoked pain (i.e. hyperpathia and wind-up pain) was seen in the chronic pain areas compared to SCINP. We conclude that damage to the spinothalamic tract (STT) is a necessary condition for the occurrence of chronic pain following SCI. However, STT lesion is not a sufficient condition since it could also be found in SCINP. The abnormal evoked pain seen in SCIP is probably due to neuronal hyperexcitability in these subjects. The fact that apparently identical sensory impairments manifest as chronic pain and hyperexcitability in one subject but not in another implies that either genetic predisposition or subtle differences in the nature of spinal injury determine the emergence of chronic pain following SCI.

We present a patient with gradual development of camptocormia, three years before a non-Hodgkin's lymphoma was diagnosed. Lymphomas are known to produce neuromuscular symptoms through several indirect mechanisms. Recent studies regard camptocormia as a primary disease of the paravertebral muscles. To our knowledge this is the first report associating camptocormia with malignancy. The possibility of a paraneoplastic syndrome is discussed.

Electrical stimulation has been sporadically used in the treatment of hemiplegia. Reported benefits include decreasing spasticity, providing a supplementary means for range of motion exercises, increasing strength, and improving local blood flow in a paretic or paralyzed limb. Some studies have also shown functional gains in the hemiplegic upper limb following treatment with electrical stimulation. Nevertheless, there have been very few reports of the use of neuromuscular stimulation to achieve new hemiplegic upper limb activity not possible without the electrical stimulation. This is a case report of a head injury patient who was able to begin ambulation with a walker, without physical assistance, for the first time in the 16 yr since his injury. A new electrical stimulation device (Handmaster) initially used therapeutically, and then functionally, provided a reliable, strong grasp and release and was instrumental in achieving the new level of function. The device proved to be easy to use in the home, giving the patient microprocessor-controlled therapeutic and patterned functional electrical stimulation.

I feel that the highlight of my research activities is bringing the topic of ‘premature morbidity and aging’ (senectus praecox), in people with spinal cord injury (SCI) and other disabilities, into public awareness.1

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

In one of Philipp Jakob Sachs von Lewenhaimb's (1627–1672) books, one may find perhaps the first illustration of a child with the split hand/split foot malformation. A short historical note and some clinical genetic data are given.

Dr Jacob Mackiewicz, a Jewish-Polish neurologist, described the cruralis phenomenon related to injury of the femoral nerve or of the fourth lumbar root. In 1912, only one year after graduation maxima cum laude from Moscow University, the 25-year-old Dr Jacob Mackiewicz described the cruralis phenomenon, regarded in the German and Slavic medical literature as the Mackiewicz sign:‘the patient lies prone, the examiner lifts the thigh in one hand, with the other hand, bends the patient's knee slowly; this manoeuvre causes severe pain in the anterior part of the thigh and over the groin. This manoeuvre indicates a femoral nerve injury’.

To examine the prevalence of coronary artery disease (CAD) and its risk factors in people with posttraumatic vision loss (PTVL).Cross-sectional, controlled study.The general community.Study groups included 82 subjects with PTVL, 49 siblings, 58 blind subjects with retinitis pigmentosa (RP), and the general population in Israel.Not applicable.Sociodemographic and biomedical data collected by using a structured questionnaire and medical records.The prevalence of CAD among subjects with PTVL (24%) was 2 to 3 times higher than the control groups ( P.001). However, the prevalence of the CAD risk factors in these subjects was similar to or lower than those in the control groups. For example, significantly fewer subjects with PTVL were physically inactive (16%) than patients with RP (55%, P.01). The only variable that was significantly associated with CAD prevalence was the cause of blindness-that is, trauma versus disease; the odds of having CAD after traumatic vision loss was 3.75 times higher than after RP.People with PTVL exhibit elevated rates of risk for CAD similar to those of other groups with physical disability. The traumatic injury that caused vision loss might be an important factor underlying that risk.

Spinal cord injury (SCI) is devastating, leaving patients wholly or partly paralyzed. Health care providers who care for SCI patients during the acute or chronic phases are faced with different phenomena in the lower extremities of these subjects. In this article, the authors review the relevant changes associated with SCI. Preventive measures of these medical complications are directed according to the specific cause. Early comprehensive rehabilitation carried out by a specialized team prevents complications while enhancing functional gains.

Zeilig G, Weingarden HP, Levy R, Peer I, Ohry A, Blumen N. Heterotopic ossification in Guillain-Barre syndrome: incidence and effects on functional outcome with long-term follow-up. Objective To define the incidence, effects on functional abilities, and possible causation of heterotopic ossification (HO) in Guillain-Barre syndrome (GBS) patients admitted for inpatient rehabilitation. Design Long-term prospective study on neurologic and functional outcome of GBS patients admitted for rehabilitation. Setting Rehabilitation department, inpatient and outpatient, within a university-affiliated medical center. Participants All GBS patients admitted for rehabilitation and followed for a minimum of 3 years. Interventions Not applicable. Main Outcome Measures Presence of HO, factors that may be etiologically significant, and effects on functionality. Data included: medical interventions, Disability Grading Scale, need for assisted ventilation, electrodiagnostic findings, autonomic function, standard neuro-musculo-skeletal evaluation, and hospital length of stay. Results Four (6%) of 65 patients had HO, 24 of whom required mechanical ventilation. All had decreased range of motion in the involved hips that affected mobility. Conclusions Even though it has been rarely reported, HO does occur in GBS and affects functional outcome.

It is important to consider a differential diagnosis between paralysis on an organic basis and paralysis and disability due to psychological mechanisms in people with physical impairment secondary to trauma, without evidence of organic etiology. We review the most dramatic type of conversion disorder (CD)-'Conversion Motor Paralysis'. Recent important medical literature concerning the accepted treatment and rehabilitation management will be reviewed and discussed. The inter-disciplinary in-patient team management approach in a rehabilitation setting offers the benefits of a comprehensive assessment and treatment. The diagnosis is temporary and conditional, since there may be a long delay until the appearance of organic findings. A complete medical assessment is essential in order to rule out any possibility of an organic etiology. In as many as 25% to 50% of patients diagnosed as conversion, an organic medical diagnosis was found.

Study design: We present our cumulative experience with patients sustaining the most dramatic type of Conversion Disorder (CD) – Conversion Motor Paralysis. Setting: Rehabilitation departments, Reuth Medical Center, Tel-Aviv and Sheba Medical Center, Tel-Hashomer, Israel. Methods: During the period 1973–2000, 34 patients with neurological symptoms without any anatomical or physiological basis were admitted to both rehabilitation departments. This number consists of less than 1% of the total acute traumatic and non-traumatic spinal cord disorders admitted annually to these centers. Results: Twenty-five of the subjects were men (mean age of 30 years) and nine were women (mean age of 31.4 years). Neurological symptoms included: paraplegia (complete or incomplete) (18), hemiplegia or hemi paresis (11), tetraplegia (complete or incomplete) (three), monoplegia (one), triplegia (one). The final diagnosis on discharge was CD in 30 of the 34 cases, the remaining four being diagnosed as malingering. Functionally, nine patients had a complete recovery, 10 a partial recovery and 15 remained unchanged. Conclusion: Disabled people who experienced traumatic events resulting in various disabilities are admitted usually to a rehabilitation center. However, some of them are later diagnosed as having Conversion Disorder or malingering. We believe that their participation in active regular and integrative rehabilitation process is beneficial to most of them. Most of these patients gain functional independence and return to the main stream of life.

We report a case of slow ascending myelopathy in a patient with ankylosing spondylitis (AS).Case report of a 60-year-old patient suffering from AS, who developed over a period of 39 years a slow ascending myelopathy leading to tetraplegia, squamous cell carcinoma of the bladder and amyloidosis of the small intestine secondary to neuropathic bladder and bowel.Department and Outpatient's Department of Neurological Rehabilitation Sheba Medical Center, Tel Hashomer, Israel.Single patient case report.Clinical follow-up of the patient between the years 1959 - 1998.Physical examination disclosed deteriorating incomplete tetraplegia with hypotonia and hyporreflexia. Neurogenic bladder and bowel complicated to squamous cell carcinoma and amyloidosis.To our knowledge, flaccid tetraplegia associated with AS, has never been reported in the literature. The possibility of vascular compression by the ankylosed spine causing the clinical picture of flaccid tetraplegia in this patient is discussed.

Dr Lazar Remen (1907-74) was the first, in 1932, to describe the beneficial effect of prostigmine on a myasthenia gravis patient. His observation actually preceeded by two years Mary Broadfoot Walker's (1888-1974) paper, which is considered to be the landmark article on this association.

Studies of pain perception in patients with chronic pain have yielded contradictory results. While several studies found that acute pain threshold is raised in chronic pain subjects, others showed that these subjects exhibit a decreased pain threshold compared to pain free subjects. The aim of this study was to further examine this topic by studying pain perception in subjects with chronic pain following partial or complete spinal cord injury (SCI). We found a significant elevation of heat-pain threshold (measured above the level of lesion) in complete SCI subjects with chronic pain (CSCIP) as opposed to complete SCI subjects without pain, incomplete SCI subjects with (ISCIP) and without chronic pain and normal controls. This elevation of pain threshold was completely reversed following a complete relief of the chronic pain by DREZ lesion. Moreover, the CSCIP exhibited significantly higher scores in the McGill pain questionnaire compared to ISCIP, indicative of a more intense chronic pain perceived by these subjects. In addition, the chronic pain below the level of spinal lesion, reported by CSCIP originated from a significantly larger body area than that of ISCIP. These results indicate that a critical level of chronic pain must be perceived in order to induce an elevation in acute pain threshold.

May I comment on some of the articles published in the last January issue of Spinal Cord. As Wyndaele1 noted in his Editor’s Page, the standard of the clinical researches which try to understand why, yet, there is no real functional regeneration of the damaged cord, improve constantly, but, alas, there is no ‘cure for paralysis’. Vikhanski2 called this enigma: ‘The Search of the Lost Cord’. Silver3 reviewed extensively the History of the Treatment of Spinal Injuries. Beyond historical background and modern scientific approaches we remain with the basic horrible unsolvable enigma, that there is no practical way to reconnect the severed billions of neurons and axons. We all stay in pray and hope.

Charles Dickens' ( 1812- 1870) works, were for a long time, a solid background for social, historical, psychological, literary and medical 19th century studies. In this article , some light is casted on Dickens, medicine and disabled people in his works, especially on paraplegics.

Study design: A case report. Setting: Department of Rehabilitation Medicine, Reuth Medical Center, Tel Aviv, Israel. Method: Summary of the clinical course during in-patient and out-patient treatment of a patient with West Nile Virus Myelitis. Results and conclusion: A healthy young woman, whose medical history revealed only a benign Duane syndrome and a few months' duration of bipolar disorder, contracted encephalo-myelitis due to a West Nile Virus infection. Although she recovered remarkably after long-term rehabilitation treatments, some weakness and pain remained. Spinal Cord (2001) 39, 662–663.

Twenty patients with spinal cord injury underwent serial electromyographic examinations. Fibrillation potentials and positive waves were noted in six patients in the spinal shock phase. In another subject, these potentials were found 27 months after injury. Our finding of significant slowing in the NCV of both nerves, indicates that lower motor neurons are indeed affected by upper motor neuron lesions. The H-reflex studies showed an increase in the mean H/M ratio. This may indicate an increase of reflex motor neuron excitability. No clear correlation was found between this increase and the degree of clinical spasticity. With repeat investigations, after a period of physical activity, a trend to reduction of the H/M ratio was noted with no clinical confirmation of reduction in spasticity. These findings emphasise the need for not assigning diagnostic terms to EMC abnormalities, but rather identifying them as neurophysiological changes which must be interpreted in the light of the clinical picture.

Among hundreds of spinal cord injured patients (SCIP) who have been rehabilitated in the Sir Ludwig Guttmann Spinal Cord Injury Unit at the Sheba Medical Centre, Tel Hashomer; we only found six patients who had lost one or more limbs (upper or lower limbs). Although many plastic and orthopaedic surgeons regard paralytic limbs as useless appendages, we cannot agree with this erroneous viewpoint and we find that the clinical and psychological effects of the absence of limb(s) are tremendous. The six case reports are given together with a brief review of the relevant literature.

We report on a traumatic paraparetic patient, who developed acute intermittent arteriomesenteric occlusion of the duodenum after the use of Harrington's spinal instrumentation. This rare condition was treated conservatively. It is presumed that some degree of hyperlordosis of the lumbar spine by the rods was responsible for this phenomenon.

Systemic humoral factors have been studied in traumatic, chronic and acute spinal cord injured patients. Antibodies specific to nervous system autoantigens were detected in a majority of the sera obtained from these patients, at different periods after injury. Limited in vitro sprouting of dorsal root ganglia in chicken embryos was observed in the presence of serum from these patients. The possible association between growth inhibiting factors and the presence of antibodies against nervous tissue autoantigens is discussed.

The vital capacity and forced expiratory volume are studied in 23 patients with spinal cord injury.