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Clinicians need to know recovery of neurologic function in the upper extremities after traumatic quadriplegia to prognosticate function in self-care, to determine the effectiveness of various interventions, and to develop a comprehensive rehabilitation plan. This study was undertaken to determine the extent of recovery of key muscles of the arms in motor complete quadriplegic subjects. The hypothesis stated that patients with some motor power (grades 1.0 to 2.5/5) in muscles in the zone of partial preservation would recover at an earlier time and to a greater extent than those with no motor power (grade 0/5). One hundred fifty subjects, C4, C5, and C6 motor complete, were entered in the study within one week of injury from four centers. Serial muscle examinations of the biceps, wrist extensors, and triceps on the right and left sides were performed up to 24 months after spinal cord injury. The pattern of recovery in the key muscles of the 67 subjects with some motor power in the zone of partial preservation to grade 3/5 was significantly greater than the 83 subjects with no motor power (68% to 82% vs 14% to 36%, p less than .001) at three to six months postinjury. The plateau of the median manual muscle test score determined the extent of recovery and reached grade 4/5 in subjects with some motor power at three to six months. The pattern of recovery revealed more subjects with some motor power improved to grade 3/5 at all intervals earlier than those with no motor power (p less than .005).(ABSTRACT TRUNCATED AT 250 WORDS)

The development of persistent hypertension in young, previously healthy paraplegic individuals is unusual; it could be postulated that hypertension is a cardiovascular response peculiar to patients who sustained spinal cord injury after surgical repair of the aorta with trauma-related injuries. In a retrospective study of 712 patients sustaining spinal cord injury during the last decade, seven sustained paraplegia after aortic repair that was necessitated by trauma-related injuries. Despite the low incidence of new-onset hypertension in paraplegic patients, five of the seven developed hypertension, of which three required chronic antihypertensive medications. It is well documented that patients with lesions of the neuraxis above the sixth thoracic segment are prone to the phenomenon of autonomic hyperreflexia. This results from interruption of the baroreceptor reflex and the descending tracts of the spinal cord. There is evidence that the renin-angiotensin system, catecholamines, and receptor-site activity play an important role in the control of blood pressure in spinal cord injured patients. Additional investigation of this rare subgroup of spinal cord injured patients may further illuminate the effect of spinal cord injury on autonomic control of the cardiovascular system.

Recommendations for exercise programs in patients with muscular dystrophy are controversial. These programs are designed to keep a patient ambulatory or functional for as long as possible. There have been no reports of a patient with muscular dystrophy who incurred a spinal cord injury. This report details the course of recovery and rehabilitation of a man with facioscapulohumeral muscular dystrophy with quadriplegia from a traumatic spinal cord injury. The patient was admitted to a spinal cord injury unit. After prolonged bedrest, he participated in physical and occupational therapy that was designed to exercise him just short of fatigue. Except for one incident, when the patient reinjured his spinal cord, he did not lose function that he had already attained. The rehabilitation of this patient demonstrates that it is possible for a patient with facioscapulohumeral muscular dystrophy who sustains a traumatic quadriplegia to enter a rehabilitation program with expectations for a good outcome despite a double disability.

This study determined the relationship between the vocational and educational plans, interests, work values, and rehabilitation outlook of patients with traumatic spinal cord injury (SCI) and their vocational and social adjustment 8 years after first hospital discharge. While hospitalized the patients were given 15 measures of vocational development on a scale ranging from 13 to 52. Reliabilities (r) of the 15 measures ranged from r = 0.77 to r = 0.96, with the average reliability of the scale measured at 0.88. Eight years after discharge each patient was sent a questionnaire covering his/her school and employment history since discharge. Occupational status was classified by 3 categories: competitive labor market, student or homemaker, and unemployed. All data were subjected to intercorrelations and factor analysis. Five persons were employed in the competitive labor market, 1 was a student, 1 had retired after working for 6 1/2 years, and 17 were unemployed. Compared to a study of the same group after 4 years, 2 more persons were employed, including 1 who subsequently retired. The best predictors after 8 years were vocational plans, work interests, work values, remotivation, rehabilitation outlook, and grade completed. Four years after discharge, the best predictors were educational and vocational plans and remotivation and rehabilitation outlook. The findings indicated that patients with traumatic SCI did not significantly enhance their employment after another 4 years in the community. Nevertheless, 6 measures of vocational development were predictive of vocational adjustment after discharge.

Colonic myoelectric activity was recorded from six para- or quadriplegic subjects with spinal cord injury and seven normal controls via bipolar electrodes in contact with the rectal mucosa. Recordings were carried out in the fasting (basal) state and after stimulation by a standard meal and by 1.0 mg neostigmine intramuscularly. The recordings were visually analyzed for spike activity, average slow wave frequency, and percentage occurrence of subsets of slow wave frequency (2-4 and 5-12 cycles/min). The spinal-cord-injured subjects had significantly more spike wave activity in the basal state than did the controls (12.6 spikes per 10 min vs 3.3). However, meal stimulation did not lead to an increase in spike activity in the spinal-cord-injured subjects (13.7 spikes per 10 min vs 12.6) while it did in the controls (6.4 vs 3.3 spikes per 10 min). Neostigmine significantly increased spike activity in both groups. There was no difference in average slow wave frequency nor any slow wave subsets between the two groups studied. Thus persons with spinal cord injuries have higher basal colonic myoelectric activity than normals but lack a demonstrable gastrocolic reflex. We conclude that the central nervous system exerts a tonic inhibitory influence on basal colonic motility and appears to participate in the gastrocolic reflex.

Cystoscopic procedures were performed on 102 patients with histories of traumatic spinal cord lesion; 57 patients had sensorimotor levels above T7, and the remaining 45 patients had levels below T7. In 40 of the 57 patients (70 per cent) with levels above T7, signs and symptoms of autonomic hyperreflexia were seen during bladder distension and cystoscopy; the remaining 17 of these patients (30 per cent) did not have this response. No autonomic hyperreflexia was seen during cystoscopy in any of the 45 patients with sensorimotor levels below T7.

A retrospective study of serum glutamic pyruvic transaminase (SGPT) and serum glutamic oxalacetic transaminase (SGOT) was performed on eighteen previously healthy patients with acute spinal cord lesions C1 to L1 and no abdominal trauma. The SGPT rose in 13 of the 17 (76%). The SGOT rose in 8 of the 17 (47%). The SGPT and SGOT values for the entire group were significantly elevated over the upper limits of normal (p less than 0.01). The mean and median days of onset of elevated SGPT after trauma were 22 and 18, respectively. The mean and median days to normalization after trauma were 67 and 64. The mean and median days of onset of elevated SGOT were 26 and 19 respectively. The mean and median days to normalization were 42 and 43. The alkaline phosphatase were elevated in all but eight patients. The bilirubin was elevated in only three patients. Seventy-six percent of the quadriplegics and 60% of the paraplegics had elevated transaminases. The elevations are probably related to liver injury but the mechanism is unclear.