Search

The history of spinal cord injury (SCI) dates back as far as the ancient Egyptians, who described it as an ‘ailment not to be treated’ ( Eltorai, 2003 ). For a long time, victims of SCI saw a bleak future confined to a wheelchair and a lifetime of comorbidities and poor survival rates ( McDonald and Sadowsky, 2002 ). It was not until after World War II that the outlook for such patients began to improve ( Eltorai, 2003 ). The development of an infrastructure for the emergency transportation of injured patients and advances in acute care and rehabilitation practices have dramatically reduced mortality and morbidity ( Talu et al. 2005 ). Therapies to enhance neurological function following SCI have been extensively investigated by the clinical and scientific community. Subsequently, significant insight has been generated into the pathology and pathophysiology of acute spinal cord trauma. It has been hypothesised that the primary mechanical injury to the spinal cord initiates a cascade of vascular, cellular and biochemical events that cause extension of the injury site. Current interventions for the acutely cord-injured patient attempt to minimise this secondary injury and protect the tissue that initially survived the mechanical injury ( Dumont et al, 2001 ; Kwon et al. 2004 ; Li and Yang, 2009 ).

OBJECTIVE: Evaluate the surgical results of axis screw instrumentation. METHODS: Retrospective evaluation of the clinical and radiological data of patients submitted to axis fixation using screws. RESULTS: Seventeen patients were surgically treated. The mean age was 41.8 years (range: 12-73). Spinal cord trauma was the most common cause of instability (8 patients - 47%). Bilateral axis fixation was performed in all cases, except one, with laminar screw (total of 33 axis screws). Seven patients (41.1%) underwent bilateral pars screws; laminar screws were used in six cases and pedicular screws were used in two. In two cases, we performed a hybrid construction (laminar + pars and pedicle + pars). There was no neurological worsening or death, nor complications directly related to use axis screws. CONCLUSION: Axis instrumentation was effective and safe, regardless of the technique used for stabilization. Based on our learnt experience, we proposed an algorithm to choose the best technique for axis screw fixation. OBJETIVO: Avaliar os resultados cirúrgicos da instrumentação com parafusos do áxis. MÉTODOS: Avaliação retrospectiva de dados clínicos e radiológicos de pacientes submetidos à instrumentação com parafusos do áxis. RESULTADOS: Dezessete pacientes foram tratados cirurgicamente. A média de idade foi de 41,8 anos (faixa: 12-73 anos). Trauma na coluna foi a causa mais comum de instabilidade (8 casos - 47%). Fixação bilateral do áxis foi realizada em todos os casos, exceto em um, com parafuso de lâmina (total de 33 parafusos). Em sete pacientes (41,1%), foram usados parafusos de pars; em seis, parafusos de lâmina; e em dois, de pedículos. Em dois casos, foi utilizada uma combinação de técnicas (pars + lâmina e pars + pedículo). Não houve piora neurológica nem complicações diretas em decorrência do uso dos parafusos. CONCLUSÃO: A instrumentação do áxis foi eficaz e segura independentemente da técnica escolhida para estabilização. Com base em nossa experiência, foi proposto um algoritmo para auxílio na escolha da melhor técnica a ser empregada.

Objective: To evaluate the effect of monosialoganglioside (GM-1) in spinal cord trauma patients seen in our service who have not been treated with methylprednisolone. Methods: Thirty patients with acute spinal cord trauma were randomly divided into two groups. In Group 1, patients received 200 mg GM-1 in the initial assessment and thereafter received 100 mg intravenous per day for 30 days and Group 2 (control) received saline. Patients were evaluated periodically (at 6 weeks, 6 months, one year and two years), using a standardized neurological assessment of the American Spinal Injury Association / International Spinal Cord Society. Results: The comparative statistical analysis of motor indices, sensitive indices for pain and touch according to the standardization of ASIA / ISCOS showed that the assessments at 6 weeks, 6 months and 2 years, GM-Group 1 patients had higher rates than the control group regarding sensitivity to pain and touch, with no statistically significant difference from the motor index. Conclusion: The functional assessment showed improvement in the sensitive indices of patients treated with GM1 after post-traumatic spinal cord injury compared to patients who received placebo. Level of Evidence IV, Prospective Case Studies Series.

WOS: 000394500100009 Amaç: Bu çalışmada spinal kord yaralanmasında antioksidan etkisi olan topiramatın sıçanlardaki nöroprotektif etkisi araştırıldı. Gereç ve yöntemler: Çalışma 40 adet Wistar albino cinsi erkek sıçan ile yapıldı. Sıçanlar yapılan işlemlere göre beş gruba ayrıldı. Grup 1 (n=8); laminektomi yapıldı, travma oluşturulmadı, tedavi verilmedi. Grup 2 (n=8); laminektomi yapıldı, travma oluşturuldu, tedavi verilmedi. Grup 3 (n=8); laminektomi yapıldı, travma oluşturuldu, salin (30 mg/kg) verildi. Grup 4 (n=8); laminektomi yapıldı, travma oluşturuldu, metilprednizolon (30 mg/kg) verildi. Grup 5 (n=8); laminektomi yapıldı, travma oluşturuldu, topiramat (30 mg/kg) verildi. Travma spinal kordun Yaşargil anevrizma klipsiyle (Aesculap FE 721 K) kliplenmesi ile oluşturuldu. Motor fonksiyonlar travma sonrası birinci günde eğik düzlem testi kullanılarak değerlendirildi. Alınan spinal kord doku örneklerinde malondialdehit (MDA), katalaz (CAT), glutatyon peroksidaz (GPx) ve süperoksit dismutaz (SOD) düzeyleri ELISA yöntemi ile ölçüldü. Bulgular: MDA yüksekliği açısından grup 1 ile grup 4 ve grup 5 arasında istatistiksel olarak anlamlı fark saptandı (p=0.013). Grup 4 ve grup 5 arasında SOD düzeyi açısından istatistiksel fark görülmedi (p=0.80). Grup 4 ve grup 5 arasında GPx düzeyi açısından istatistiksel olarak anlamlı fark saptanmadı (p=0.51). Grup 4 ve grup 5 arasında CAT düzeyi açısından istatistiksel fark görülmedi (p=0.38). Eğik düzlem testinde motor aktivite açısından grup 4 ve grup 5’in sonuçları tedavi grupları arasında en iyi değere sahipti. Histopatolojik incelemede grup 4 ve grup 5’te travma sonrası kesitlerde minimal ödem, normale yakın gri ve beyaz cevher bulguları izlendi. Sonuç: Sıçanlarda oluşturulan akut spinal kord travma modelinde biyokimyasal belirteçler, histolojik inceleme, motor fonksiyon değerlendirme verilerine dayanılarak, topiramatın nöroprotektif etkili olduğu, omurilik travmalarının akut tedavisinde kullanılabileceği, ancak bu konuda daha çok çalışmaya ihtiyaç olduğu görüşündeyiz. kg) was given. The trauma was created through clipping the spinal cord by Yasargil aneurysm clip (Aesculap FE 721 K). Motor functions were evaluated by using the inclined plane test on the first day after injury. Malondialdehyde (MDA), catalase (CAT), glutathione peroxidase (GPx) and superoxide dismutase (SOD) levels in the spinal cord tissue samples taken, were measured by ELISA method. Results_ We found statistically significant difference for high levels of MDA between group 1 and groups 4 and 5 (p=0.013). There was no statistically significant difference in terms of SOD level between group 4 and group 5 (p=0.80). There was no statistically significant difference for GPx levels between group 4 and group 5 (p=0.51). There was no statistically significant difference for CAT levels between group 4 and group 5 (p=0.38). Results of group 4 and group 5 had the best value among the treatment groups in motor activity examination by inclined plane test. We observed minimal edema and near-normal gray and white matter findings in the posttraumatic sections of group 4 and group 5 in the histopathological examination. Conclusion_ We think that topiramate has a neuroprotective effect that can be used in the treatment of acute spinal cord injury in rats, based on biochemical markers, histological examination and motor function assessment data, but there is the need for further studies on this matter_

Establecer el nivel de adherencia a procesos de neurorehabilitación funcional a largo plazo y su relación con la discapacidad y la calidad de vida relacionada con la salud en adultos con lesión medular crónica de Manizales, Colombia. Materiales y métodos: Se realizó un estudio descriptivo de alcance correlacional con 39 personas mayores de 18 años de la ciudad de Manizales, que tuvieran lesión medular de más de seis meses de evolución. Este estudio se llevó a cabo durante el segundo semestre de 2014. Se aplicaron los siguientes instrumentos de evaluación: SCI-DAS para evaluar la discapacidad, SMAN para determinar la adherencia a procesos de neurorehabilitación funcional y WHOQOL-BREF para establecer la calidad de vida relacionada con la salud de la población con lesión medular. Resultados: Se halló relación directa estadísticamente significativa entre la discapacidad global y el factor socioeconómico y entre la misma y el factor discapacidad de la variable adherencia. Para las variables adherencia a procesos de neurorehabilitación funcional y calidad de vida relacionada con la salud (CVRS) se encontró relación también directa y estadísticamente significativa entre los componentes factor socioeconómico y factor discapacidad de la adherencia con la CVRS general y su componente ambiente. Por último, se evidenció relación estadísticamente significativa de carácter inverso entre la discapacidad global y sus dos componentes (actividades y participación, y factores ambientales) con todos los componentes de la CVRS general. Conclusiones: Los hallazgos generales evidenciaron que sólo se encontró una relación significativa entre CVRS y discapacidad global con todos sus componentes, mientras que las otras relaciones como CVRS-adherencia y adherencia-discapacidad mostraron relaciones estadísticamente significativas sólo entre algunos de los componentes de las mismas. Todo esto permite concluir que a mejor calidad de vida se mejoran los procesos de adherencia y que a mayor discapacidad es menor la calidad de vida como la adherencia a procesos terapéuticos. To establish the level of adherence to long-term functional neurorehabilitation processes and its relationship with disability and health-related quality of life in adults with chronic spinal cord injury from Manizales, Colombia. Materials and methods: A descriptive study of correlational scope was carried out with 39 people older than 18 years of the city of Manizales, who had spinal cord injury of more than six months of evolution. This study was carried out during the second semester of 2014. The following assessment instruments were applied: SCI-DAS to assess disability, SMAN to determine adherence to functional neurorehabilitation processes and WHOQOL-BREF to establish related quality of life with the health of the population with spinal cord injury. Results: A statistically significant direct relationship was found between global disability and the socioeconomic factor and between it and the disability factor of the adherence variable. For the variables adherence to functional neurorehabilitation processes and health-related quality of life (HRQOL), a direct and statistically significant relationship was also found between the socioeconomic factor and disability factors of adherence with the general HRQOL and its environmental component. Finally, there was a statistically significant inverse relationship between global disability and its two components (activities and participation, and environmental factors) with all components of the general HRQL. Conclusions: The general findings evidenced that only a significant relationship was found between HRQL and global disability with all its components, while the other relationships such as HRQL-adherence and adherence-disability showed statistically significant relationships only between some of their components. All this allows us to conclude that the better the quality of life, the better the adherence processes and that the greater the disability the lower the quality of life as well as the adherence to therapeutic processes.

Pediatric spinal trauma is relatively rare with roughly 5% of injuries occurring in this group. Cervical spinal trauma is most common in the pediatric population, followed by thoracic and lumbar injuries. The biomechanics of the evolving pediatric anatomy alter the injury characteristics and radiographic interpretation of pediatric spinal trauma patients. Systematic assessment paradigms are necessary in the evaluation and treatment of pediatric spinal cord trauma patients. Common treatment modalities for this subgroup of patients include halo fixation, bracing, and surgical instrumentation. While the surgical management options for pediatric spinal injuries have improved, the anatomical considerations associated with the size and growth potential of pediatric patients provide room for improvement of these modalities.

A 2-year-old castrated male Holland lop rabbit ( Oryctolagus cuniculus ) was presented for loss of hind limb motor function after leaping from the owner's arms. Results of a neurologic examination revealed appropriate mentation, normal thoracic limb posture and gait, paralysis in the right pelvic limb, and voluntary movement of the left pelvic limb. Superficial pain perception and withdrawal reflexes were present bilaterally in the hind limbs. Bilateral proprioception was evident in the forelimbs but absent in the hind limbs. Standard radiographs and a myelogram were performed, revealing subluxations at T5-T6, L1-L2, and L3-L4, a comminuted fracture of the T9 vertebral body, fractures of the right articular facets of L3-L4, and spinal cord swelling at T9. The clinical signs continued to decline, resulting in paraplegia with loss of deep pain perception in the left hind limb after the myelogram procedure. The owners of the rabbit were given a guarded-to-poor prognosis for the animal to regain mobility in the hind limbs. The rabbit was hospitalized and medical treatment including pain management, intravenous fluid therapy, nutritional support, and cage rest was initiated. After the initial decline of the clinical signs, the neurologic deficits stabilized during hospitalization. At the time of discharge, partial voluntary movement had been regained in the right hind limb, but there was no movement or pain perception in the left hind limb. This gradually resolved over 3 months of conservative therapy, at which point the rabbit had recovered the voluntary movement in both hind limbs and was able to ambulate by walking and hopping. This case report documents acute spinal cord trauma in a rabbit, as well as recovery of the neurologic deficits after prolonged medical management.

Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Médico-Cirúrgica O traumatismo vertebro-medular implica a presença de alterações estruturais ou fisiológicas dos elementos que constituem a coluna vertebral ou a medula espinal provocadas por forças energéticas externas que atingem o corpo humano. A lesão vertebro-medular tem efeitos dramáticos nas vidas das pessoas afetadas e das suas famílias. Esta patologia é frequentemente geradora de incapacidade motora e sensitiva provocando paraplegia ou tetraplegia completa ou incompleta nas pessoas lesadas. Neste sentido, pessoas com vida ativa afetadas por esta patologia vêm a sua vida pessoal, profissional e social sofrer uma alteração drástica, ficando impossibilitadas de trabalhar nas suas atividades laborais, bem como de realizar simples tarefas do dia-a-dia como andar, vestir, alimentar-se, entre outras necessidades básicas, que a pessoa fica impossibilitada de fazer. Face às mudanças de vida que o traumatismo vertebro-medular provoca no ser humano considerámos fazer uma pesquisa aprofundada, uma revisão sistemática da literatura, sobre a prestação de cuidados de qualidade ao cliente com traumatismo vertebro-medular agudo de modo a prevenir o agravamento da lesão inicial, e consequentemente, o surgimento de complicações. A pesquisa realizada nas bases de dados bem como a efetuada nos locais de estágio hospitalar (serviço de urgência, cuidados intensivos e unidade vertebro-medular) permitiu-nos concluir que atualmente as práticas utilizadas a nível pré-hospitalar, serviço de urgência, cuidados intensivos, serviço de internamento são muito atualizadas e cumprem as guidelines mais recentes. Verificámos também que a atuação precoce, correta e de qualidade dos profissionais de saúde desde o local do acidente onde ocorreu o trauma, ao serviço de urgência e cuidados intensivos ou serviço de internamento é essencial para prevenir a lesão medular, o agravamento da mesma caso tenha ocorrido, bem como possíveis complicações. Resumindo as competências comuns e específicas dos enfermeiros especialistas em Enfermagem Médico-Cirúgica são a base para uma prestação de cuidados de qualidade à pessoa vítima de trauma vertebro-medular. Deste modo, o enfermeiro especialista deve supervisionar, coordenar, orientar a prestação de cuidados a estes clientes de modo a que toda a equipe haja organizadamente prevenindo o surgimento de mais lesões na pessoa vítima de trauma. Abstract: The spinal cord injury implies the presence of structural or physiological changes of the spine or spinal cord elements caused by external energy forces that affect the human body. The spine or spinal cord injury has a dramatic effect on the lives of those affected and their families. This condition often generates a motor and sensory disability causing complete or incomplete paraplegia or tetraplegia to the people who were injured. In this sense, active people affected by this disease have their personal, professional and social life dramatically changed, becoming unable to work in their professional activities and to perform simple diary tasks such as walking, dressing , feeding, among other basic human needs that the person is unable to do. Given the life changes that the spinal cord trauma causes in humans, we have considered to do a deep research, a systematic review of literature, about a quality care to the patient with acute spinal cord trauma in order to prevent the worsening of the injury and consequently some complications. The databases research as well as the hospital training research ( in emergency department, intensive care unit and spinal cord unit) allowed us to conclude that currently the practices used in pre-hospital setting, emergency department, intensive care unit and inpatient service are up to date and follow the latest guidelines. We also found that early correct and quality care assistance by health professionals from the crash site, where the trauma occurred, to the emergency department and intensive care or inpatient service is essential to prevent spinal cord injury, the injury deterioration and possible complications. Summarizing the common and specific skills of Medical Chirurgical specialists nurses are the basis for the provision of quality care to the person victim of spinal cord trauma. Thus, the specialist nurse should supervise, advise, coordinate, guide these patients care so that the whole team is being organized, preventing more injuries to the trauma victims.

A 41-year-old man presented with bilateral shoulder weakness and pain. The symptoms had been present for 5 years on the left side and for 3 years on the right. His medical history was remarkable for cervical trauma related to a fall 8 years earlier. Neurologic examination showed severe bilateral weakness of shoulder abduction, with atrophy of the deltoid, supraspinatus, and infraspinatus muscles (Fig. 1). Biceps tendon reflexes were decreased bilaterally. Electromyography findings were consistent with bilateral C5–C6 radiculopathy. Magnetic resonance imaging revealed a spinal intradural arachnoid cyst extending from the level of C2 to L3 (Fig. 2), displacing the spinal cord posteriorly. Computed tomography-myelography showed early filling of this cyst with contrast material, suggesting a large communication with the subarachnoid space. The patient underwent an L2–L3 laminotomy with cyst fenestration and shunting. Three months after surgery, a slight improvement of strength was noticed. Radiculopathy or myelopathy resulting from compression by a spinal cyst is rare. Nabors et al. classified spinal cysts as extradural without spinal nerve root involvement (Type I), extradural with spinal nerve root involvement (Type II), and intradural (Type III) [1]. Arachnoid cysts, the most common spinal intradural cysts, are either congenital or acquired. The majority of acquired arachnoid cysts develop after spinal cord trauma, subarachnoid hemorrhage, or infection [2]. These lesions are usually posterior to the spinal cord in the thoracic region. Subarachnoid cysts anterior to the spinal cord, which are less common, generally have greater craniocaudal extension and are often associated with previous trauma [2]. The extensive subarachnoid cyst in this case is very likely related to the reported previous trauma. It is possible that the findings were the result of stretch or compression injuries to the nerve roots.

Формування обхідних шляхів спинномозкової іннервації є важливою альтернативою хірургічним та терапевтичним методам лікування, спрямованим на відновлення провідності ушкодженої ділянки спинного мозку. Проаналізовані результати хірургічного лікування 21 хворого з наслідками травматичного ушкодження спинного мозку. У 10 хворих з приводу ушкодження шийних сегментів спинного мозку виконана операція невротизації гілок серединного нерва з використанням гілки м’язово-шкірного, у 6 з приводу ушкодження поперекових сегментів — невротизація стегнового нерва з використанням затульного, у 5 з приводу ушкодження нижньогрудних сегментів — реімплантація корінців поперекового потовщення в проксимальну куксу спинного мозку. Результати лікування оцінювали за допомогою клінічних та електрофізіологічних методів дослідження. В усіх хворих після невротизації серединного нерва з використанням м’язово-шкірного досягнуте відновлення функції м’язів–згиначів пальців. У 9 з 10 хворих сила цих м’язів відновилася до 3–4 балів. В усіх хворих, яким виконано невротизацію стегнового нерва з використанням затульного, сила чотириголового м’яза стегна після операції становила 3–4 бали. Після реімплантації корінців поперекового потовщення в проксимальну куксу спинного мозку у 3 хворих частково відновився контроль функції сечового міхура, у 2 — відновились рухи в нижніх кінцівках, сила м’язів стегна 2 бали. Отже, операції формування обхідних шляхів спинномозкової іннервації є дієвим методом відновлення втрачених функцій у хворих з наслідками травматичного ушкодження спинного мозку.

Background The use of steroids in traumatic spinal cord injury (SCI) in children is controversial. There is a paucity of literature on its usage. To help clarify recommendations on steroid use in children, we reviewed the current literature on the administration of high dose methylprednisolone (MP) use in traumatic spinal cord injuries with an emphasis in pediatric spinal cord trauma. Methods A retrospective review of the current literature on traumatic spinal cord injuries was conducted. Outcomes were critically reviewed from the National Acute Spinal Cord Injury Studies (NASCIS) II and III and Cochrane review; as well as, other randomized and retrospective studies. Papers describing objective neurological outcomes were only included. Results The outcomes of neurological improvement following steroid infusion have not been reproducible outside of the NASCIS and one single Japanese trial. High dose steroids significantly increase the risk of infections leading to prolonged hospital stay and ventilator dependence. Conclusion Data from adult studies remains controversial with insufficient data to support administration of MP for treatment of traumatic spinal cord injuries. Randomized controlled trials are needed in the pediatric population to assess the advantages of steroid use after SCI in children. On the basis of the current evidence, the use of steroids in patients is associated with increased infectious risks and no neurological improvements.

Several clinical, imaging, and therapeutic factors affecting recovery following spinal cord injury (SCI) have been described. A systematic review of the topic is still lacking. Our primary aim was to systematically review clinical factors that may predict neurological and functional recovery following blunt traumatic SCI in adults. Such work would help guide clinical care and direct future research. Both Medline and Embase (to April 2008) were searched using index terms for various forms of SCI, paraplegia, or quadri/tetraplegia, and functional and neurological recovery. The search was limited to published articles that were in English and included human subjects. Article selection included class I and II evidence, blunt traumatic SCI, injury level above L1-2, baseline assessment within 72 h of injury, use of American Spinal Injury Association (ASIA) scoring system for clinical assessment, and functional and neurological outcome. A total of 1526 and 1912 citations were located from Medline and Embase, respectively. Two surgeons reviewed the titles, abstracts, and full text articles for each database. Ten articles were identified, only one of which was level 1 evidence. Age and gender were identified as two patient-related predictors. While motor and functional recovery decreased with advancing age for complete SCI, there was no correlation considering incomplete ones. Therefore, treatment should not be restructured based on age in incomplete SCI. Among injury-related predictors, severity of SCI was the most significant. Complete injuries correlated with increased mortality and worse neurological and functional outcomes. Other predictors included SCI level, energy transmitted by the injury, and baseline electrophysiological testing.

Objective. Scientific-practical and economical substantiation of the expedience of urgent spine surgery centre organization in megalopolises for the admittance of patients not only with acute spine and spinal cord trauma, but also with other urgent spinal pathologies. Material and Methods. Authors performed retrospective analysis of work of neurosurgical departments in large municipal hospitals of St. Petersburg during the last two years. Results. It was found out that almost all neurosurgical departments in municipal multi-field hospitals, except for the St. Petersburg Research Institute of the First Aid n.a. I.I. Dzhanelidze, do not provide a modern level of specialized medical care to patients with urgent surgical pathology of the spine. Conclusion. Working experience of the Centre for Urgent Spine Surgery created on the base of St. Petersburg Research Institute of the First Aid n.a. I.I. Dzhanelidze demonstrated that such organizational pattern allows for improving the quality of specialized medical care and more effective municipal healthcare utilization.

Background The ability to objectively analyze gait in a clinical environment is challenging due to time, space and cost constraints. This study investigated the validity of a portable gait assessment tool in objectively assessing the temporal gait parameters in subjects with spinal cord injury. The portable gait assessment tool consisted of a pair of insoles instrumented with force sensing resistors that were strategically positioned over the sole of each foot. Aim To demonstrate the validity of the gait assessment tool by assessing the change in walking ability in incomplete spinal cord injured (ISCI) subjects, who participated in a robot-assisted gait training program. Methods Eighteen subjects with either an acute or chronic ISCI participated in this study (age range 26–63 years). Each subject participated in a robot assisted gait training programme for 6 weeks. Assessments were performed using the gait assessment tool before during and after the intervention. Results The gait assessment tool showed greater sensitivity to the change in the subject's gait, when compared to clinical assessments such as the walking index in spinal cord injury (WISCI II). Subjects with an acute ISCI showed a statistically significant ( p Discussion and conclusion This study for the first time has used the gait assessment tool in an ISCI population and has demonstrated that gait parameters can be measured and changes can be quantified within a clinical environment. The statistically significant changes during the first 3 weeks of training may indicate that an effective dose of robotic training can be administered within a relatively short period in ISCI subjects during the acute phase.

PurposeThe purpose of this paper is to describe a standing style transfer system, ABLE, designed to enable a person with disabled lower limbs to do daily‐life activities without special infrastructure. Actually, ABLE is mainly intended for use by people who have spinal cord injuries and who cannot move hip joints and lower extremities: the level of spinal cord injury is L1.Design/methodology/approachABLE comprises three modules: a powered lower extremity orthosis, a pair of telescopic crutches, and a pair of mobile platforms. When traveling in a standing position, the user wears the powered lower extremity orthosis to fix his posture, and rides on the mobile platforms. The user uses crutches to keep his body stable. These telescopic crutches also play an important role of power assistance in standing‐up and sitting‐down motions, or going up/down a step. The user can enter narrow spaces, although stability is emphasized in wide spaces because it is possible to alter the contact points of the crutches freely.FindingsMotions are discussed in a standing position: traveling and rotating, and the chair and step motions. Experimental results related to these motions confirm the design's effectiveness. The authors improve previously developed mobile platforms for better operationality and stability. An ultrasonic motor was used for steering the mobile platform instead of the prior DC motor. The benefits of the ultrasonic motor enable the new platform to reduce its backlash in steering. A supporting plate and an active ankle joint attached to each mobile platform contribute stability when traveling in the standing position. The authors show the experimental results using new mobile platforms.Originality/valueThe paper demonstrates novelty and originality of ABLE in its composition, which enables a person with disabled lower limbs to travel in a standing position on a pair of small mobile platforms. This system is regarded as a biped‐type leg‐wheeled robot system that has high energy efficiency and good mobility for steps because of its wheels and legs; moreover, it has a pair of crutches for stability.

Spinal cord injury (SCI) is the sudden onset of a traumatic disabling condition. It impacts on people with SCI physiologically, psychologically and socially. People face major life changes and the lifelong challenges of disabilities that affect every aspect of their lives. This paper is a reflection on the impact of individual music therapy sessions and combined social work and music therapy group sessions, the music therapy program (MTP), on adjustment to SCI. Reflections focused on data drawn from group discussions, semi-structured satisfaction interviews of 13 men with SCI, who had undergone primary rehabilitation in the Royal Talbot Rehabilitation Centre, Melbourne, Australia; findings from an independent evaluation of MTP; and practitioner perceptions. Three themes were identified during this reflection. These were: Music as a conduit; Music and the body; and Music as a connector. Reflections identify a number of benefits of incorporating the MTP in rehabilitation programs for men with SCI.

Spinal cord injury (SCI) is a devastating event often resulting in permanent neurologic deficit. Research has revealed an understanding of mechanisms that occur after the primary injury and contribute to functional loss. By targeting these secondary mechanisms of injury, clinicians may be able to offer improved recovery after SCI.In this review, we highlight advances in the field of SCI by framing three questions: (1) What is the preclinical evidence for the neuroprotective agent riluzole that has allowed this agent to move into clinical trials? (2) What is the preclinical evidence for Rho antagonists that have allowed this group of compounds to move into clinical trials? (3) What is the evidence for early surgical decompression after SCI?We conducted a systematic review of MEDLINE and EMBASE-cited articles related to SCI to address these questions.As a result of an improved understanding of the secondary mechanisms of SCI, specific clinical strategies have been established. We highlight three strategies that have made their way from bench to bedside: the sodium-glutamate antagonist riluzole, the Rho inhibitor Cethrin, and early surgical decompression. Each of these modalities is under clinical investigation. We highlight the fundamental science that led to this development.As our understanding of the fundamental mechanisms of SCI improves, we must keep abreast of these discoveries to translate them into therapies that will hopefully benefit patients. We summarize this process of bench to bedside with regard to SCI.

When someone suffers a spinal cord injury (SCI) many organs, including those of the cardiovascular (CV) system, cease to be controlled by the autonomic nervous system (ANS). Response to physical activity fails to meet the needs of the body and typically results in low blood pressure (BP), and in turn, reduced endurance and performance. This study examines the effect of SCI on the ANS of elite athletes and possible effect on their CV functions and ultimately their performance. The study also provides input on evidence of boosting and the current classification system. Finally, authors are exploring a possibility for future research in assessing whether consideration of ANS function would strengthen current Paralympic classification systems.MEDLINE, SportDiscus, Embase databases and the official Paralympic website were reviewed. In total, 60 manuscripts and five website documents were reviewed.Athletes with high-level SCI affecting the ANS have limited ability to regulate their heart rate and BP in response to exercise. According to current Paralympic classification systems, these athletes are grouped with competitors who have similar motor control but intact ANS, thereby potentially putting them at a disadvantage within their own classification category. High-level SCI athletes with ANS dysfunction are also the only athletes who experience episodes of autonomic dysreflexia (AD). Whereas AD is a state of uninhibited sympathetic discharge, it is called 'boosting' when intentionally induced during competition. Boosting has been shown to improve sporting performance but can also cause serious complications due to extreme rises in BP. Therefore, boosting has been banned by the International Paralympic Committee (IPC). Despite this ban some elite high-level SCI athletes continue to boost. The IPC recognizes that the current classification systems are not the gold standard and further work is needed to create a more evidence-based classification.Further research is needed to determine if the inclusion of ANS parameters contributes to strengthen classifications systems in Paralympic sports. This includes the development of a simple, valid and reliable bedside assessment of autonomic function that can be used to reliably compare athletes with or without ANS dysfunction thereby enabling further research into the isolated effect of ANS dysfunction on sporting performance. Researchers who are studying individuals with SCI, and who have CV parameters as their outcomes, should ensure a homogenous study group by the presence or absence of ANS function in addition to level of lesion so as to eliminate the potential for confounding variables that lead to inaccurate interpretation of results.

This study was carried out as a postal survey. The aim of this study was to ascertain employment after paraplegia in India. This study was conducted in India. The study was conducted by means of a questionnaire. This questionnaire was mailed to the identified individuals (n=600) on the addresses obtained from the medical records section of hospitals and from various organisations. Data analysis was carried out by using descriptives. The return rate was 46% (276/600) and the employment rate was 41% (114/276). Among 114 subjects who were employed, 68 (59.6%) were living in centres run by armed force and 46 (40.4%) were living in specialised centres or under the region of non-governmental organisations. Individuals who were employed were living either in centres run by armed force or in specialised centres. None of the individuals living in community was employed.

Item does not contain fulltext STUDY DESIGN: Prospective multicenter cohort study. OBJECTIVES: To compare the neurological recovery and functional outcomes between traumatic central cord syndrome (TCCS) patients and motor incomplete tetraplegic patients. SETTING: European Multicenter Study of human spinal cord injury. METHODS: In 248 traumatic motor incomplete tetraplegics, initial phase (0-15 days) American Spinal Injury Association (ASIA) impairment grading, upper and lower extremity motor scores (UEMS and LEMS), upper and lower sensory scores and chronic phase (6 or 12 months) neurological outcomes were analyzed. In addition, chronic phase self-care and indoor mobility Spinal Cord Independence Measure (SCIM) items were studied. Tetraplegics were subdivided into three groups: (1) non-TCCS group (UEMS>/=LEMS), (2) intermediate-TCCS group (UEMS=(1-9 points)/=10 points)

Prospective cross-sectional multicenter study.To evaluate the correlation, sensitivity, specificity and predictive values of S4-5 dermatome and the anorectal examination for determination of sacral sparing in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination.Two tertiary hospitals that specialize in pediatric spinal cord injuries.In all, 189 patients who were at minimum 3 month after spinal cord injury participated in complete ISNCSCI examinations. All examiners completed training for the proper completion of the ISNCSCI examination. Correlations and sensitivity/specificity analyses were conducted between S4-5 dermatome testing and the anorectal examination. Results were analyzed by age of patient, examiner, tetraplegia/paraplegia classification and injury level (T10-S3, L1-S3 and S3).The correlation between S4-5 dermatome and anorectal sensation was moderate (0.62, P0.001). Using the anorectal examination as the gold standard, the sensitivity of S4-5 testing was 0.60 (0.49, 70) and specificity was 0.96 (0.90, 0.99). No single age group, tester, level, or type of injury differed from the overall result.In the pediatric population, the correlation between S4-5 and anorectal sensation was lower than anticipated. The sensitivity of 0.62 for S4-5 testing and diminished sensation between T10 and S3 suggests that anorectal testing may either be a more sensitive representation of S4-5 function or activate an alternative neuronal pathway that is perceived by the patient. Further investigation into the validity of the sacral sparing components of the ISNCSCI examination is warranted.

Female Wistar rats (225 g) underwent spinal cord injury (SCI) at the T4 segment and were assigned to one of the three groups treated with: (1) saline; (2) 7.5 mg kg(-1) Reparixin; or (3) 15 mg kg(-1) Reparixin. Reparixin is a small molecule, allosteric noncompetitive inhibitor of CXCR1 and CXCR2 chemokine receptors involved in inflammation.Spinal cord homogenates at 12 and 72 h post-SCI were assayed for tumor necrosis factor α (TNF-α) and cytokine-induced neutrophil chemoattractant (CINC)-1 using enzyme-linked immunosorbant assay (ELISA). Myeloperoxidase activity and western blots for CD68, Fas and p75 content were used to assess inflammation and death receptor ligands, respectively. Histopathology and neurological outcomes were assessed by immunohistochemistry, locomotion scoring and cardiovascular measurement of autonomic dysreflexia 4 weeks post-SCI.Both 7.5 and 15 mg kg(-1) doses of Reparixin reduced levels of TNF-α and CINC-1 72 h post-SCI and decreased macrophage (CD68) content in the spinal cord lesion. Only 15 mg kg(-1) Reparixin reduced both Fas and p75 levels in the spinal cord compared with untreated SCI. We observed a reduced lesion area and increased neuron number in the gray matter of Reparixin-treated rats. Hindlimb motor scores at 7 and 28 days post-SCI were improved by 15 mg kg(-1) Reparixin treatment. Both 7.5 and 15 mg kg(-1) Reparixin reduced development of autonomic dysreflexia 4 weeks post-SCI. The change in mean arterial pressure, induced by cutaneous or visceral stimulation, was reduced by 40-50%.Acute treatment with 15 mg kg(-1) Reparixin reduces acute inflammation and is associated with minor improvements in motor function and a significant reduction in the severity of autonomic dysreflexia.

Prospective longitudinal experimental study.The aim of this study was to assess the sensitivity to change of the electrical perceptual threshold (EPT) test during the longitudinal monitoring of neurological changes in patients with incomplete spinal cord injury (SCI).National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust, Buckinghamshire, UK.Perceptual threshold to 3 Hz cutaneous electrical stimulation was measured in 11 patients with incomplete SCI at selected American Spinal Injuries Association (ASIA) sensory key points on four occasions. The first three measurements were performed within a 5-day period (baseline) and the fourth measurement (follow-up) at least 9 months later. The results were tested for statistical significance and the effect sizes were calculated.There were no significant differences between the EPT results of the three baseline assessments. When the mean baseline and follow-up EPT results were compared, there were no significant differences in EPT values above the sensory level of lesion, but a significant difference (reduction in threshold values) was found at and below the level of SCI, with medium and large effect sizes, respectively.The EPT test showed good sensitivity to change in dermatomes at and directly below the sensory level of the SCI. This makes it a potentially useful quantitative sensory instrument for detecting changes in sensory function during longitudinal monitoring of patients with SCI.

Les blesses medullaires ont un dysfonctionnement erectile. Le retablissement de l’erection necessite habituellement un traitement pharmacologique. Les injections intracaverneuses (IIC) de substances vasoactives peuvent induire une erection prolongee pour un priapisme. Le traitement recommande des priapismes est une ponction du corps caverneux et/ou une IIC de substance alphamimetique. Nous proposons un traitement des erections prolongees et des priapismes par midodrine per os (alphamimetique). Notre etude concerne 354 blesses medullaires presentant un dysfonctionnement erectile et traites par IIC de substances vasoactives (prostaglandine et/ou Papaverine®). Quatorze blesses medullaires ont presente un priapisme traite par midodrine per os. Une evaluation de la detumescence et une surveillance de la tension et du pouls ont ete realisees pour tous les patients. Pour les 14 patients, le traitement a entraine une detumescence 30 a 45 minutes apres la prise de 15 mg de midodrine per os, sans effet secondaire genant. Le traitement des dysfonctionnements erectiles du blesse medullaire par IIC de substances vasoactives a considerablement augmente l’incidence des erections prolongees et des priapismes. Le traitement recommande des priapismes consiste a realiser une ponction des corps caverneux et/ou une injection de substance alphamimetique intracaverneuse. Ces traitements sont efficaces, mais peuvent entrainer des troubles de l’erection definitifs. Les traitements per os des priapismes ne sont pas recommandes. Le traitement par midodrine per os des priapismes induits par IIC de substances vasoactives chez le blesse medullaire est efficace, non invasif et n’entraine pas d’effet secondaire genant. La midodrine per os est un nouveau traitement efficace non invasif des erections prolongees et des priapismes induits par IIC de substances vasoactives chez le blesse medullaire. Il pourrait etre propose comme traitement de premiere intention des priapismes ischemiques.

We analyzed delayed effects of transplantation of nervous and hemopoietic fetal cells to patients with consequences of spinal trauma. A decrease in neurological deficit associated with pronounced improvement of functional independence was observed in 48.9% cases. The best results were observed in patients receiving cell transplantation within the first 2 years after trauma and in younger individuals. The pattern of morphological changes in the spinal cord at site of injury, severity of damage, and the method of transplantation had no appreciable effects on its delayed results.

Item does not contain fulltext STUDY DESIGN: A questionnaire survey. OBJECTIVES: To evaluate the need for the introduction of quantitative diagnostic criteria for the traumatic central cord syndrome (TCCS). SETTING: An online questionnaire survey with participants from all over the world. METHODS: An invitation to participate in an eight-item online survey questionnaire was sent to surgeon members of AOSpine International. RESULTS: Out of 3340 invited professionals, 157 surgeons (5%) from 41 countries completed the survey. Whereas most of the respondents (75%) described greater impairment of the upper extremities than of the lower extremities in their own TCCS definitions, symptoms such as sensory deficit (39%) and bladder dysfunctions (24%) were reported less frequently. Initially, any difference in motor strength between the upper and lower extremities was considered most frequently (23%) as a 'disproportionate' difference in power. However, after presenting literature review findings, the majority of surgeons (61%) considered a proposed difference of at least 10 points of power (based on the Medical Research Council scale) in favor of the lower extremities as an acceptable cutoff criterion for a diagnosis of TCCS. Most of the participants (40%) felt that applying a single criterion to the diagnosis of TCCS is insufficient for research purposes. CONCLUSION: Various definitions of TCCS were used by physicians involved in the spinal trauma care. The authors consider a difference of at least 10 motor score points between upper and lower extremity power a clear diagnostic criterion. For clinical research purposes, this diagnostic criterion can be considered as a face valid addendum to the commonly applied TCCS definition as introduced by Schneider et al. 01 september 2010

Drugs to protect vulnerable neurons and encourage neural circuits to reform could one day improve the outlook for patients with acute spinal cord trauma.

Aim To document the detection of underlying low-attenuation spinal cord or brain stem injuries in the presence of the “pseudo-CT myelogram sign” (PCMS) on post-mortem computed tomography (PMCT). Materials and methods The PCMS was identified on PMCT in 20 decedents (11 male, nine female; age 3–83 years, mean age 35.3 years) following fatal blunt trauma at a single forensic centre. Osseous and ligamentous craniocervical region injuries and brain stem or spinal cord trauma detectable on PMCT were recorded. PMCT findings were compared to conventional autopsy in all cases. Results PMCT-detected transection of the brain stem or high cervical cord in nine of 10 cases compared to autopsy (90% sensitivity). PMCT was 92.86% sensitive in detection of atlanto-occipital joint injuries ( n= 14), and 100% sensitive for atlanto-axial joint ( n= 8) injuries. PMCT detected more cervical spine and skull base fractures ( n= 22, and n= 10, respectively) compared to autopsy ( n= 13, and n= 5, respectively). Conclusion The PCMS is a novel description of a diagnostic finding, which if present in fatal craniocervical region trauma, is very sensitive for underlying spinal cord and brain stem injuries not ordinarily visible on PMCT. Its presence may also predict major osseous and/or ligamentous injuries in this region when anatomical displacement is not evident on PMCT.

Charcot spinal arthropathy is a relatively rare, destructive process characterized by a cycle of progressive deformity, destruction, and worsening instability as a result of repetitive trauma and inflammation. It may result from nontraumatic as well as traumatic causes. Historically, patients with severe symptomatic instability have been successfully treated with combined anterior and posterior fusion techniques. The long-term outcomes and potential complications, however, have not been well reported. The authors report on 2 such cases of Charcot spinal arthropathy treated surgically, one with a traumatic and one with a nontraumatic etiology. They include the unique pitfalls encountered while treating these patients, as well as their surgical treatments, complications, and long-term results.

A cross-sectional design.To examine the length-tension relationship of dorsiflexion (DF) and plantarflexion (PF) muscle groups in seven individuals with chronic spinal cord injury (SCI; C2-T7; age 43+/-10.1 years) and compare it with a group of age and sex-matched able-bodied (AB) controls.McMaster University, Hamilton, ON, Canada.Isometric single twitch properties, 0.5-s tetanic contractions (SCI) and maximal voluntary contractions (AB) were measured at nine joint angles from 20 degrees DF to 20 degrees PF.In the DF muscles, peak-evoked twitch (PT) torque occurred at 20 degrees PF for SCI (3.4+/-1.1 N m) and AB (3.8+/-1.4 N m) with no difference in peak torque between groups, whereas peak summated force occurred at 10 degrees PF in AB and 20 degrees PF in SCI (P0.01). In the PF muscles, PT torque occurred at 15 degrees DF in AB (18.6+/-2.6 N m) and at 5 degrees DF (6.8+/-3.3 N m; P0.01) in SCI, and peak-summated force occurred at 15 degrees DF in AB. The SCI group did not show any change in PF peak-summated force with varying joint angles. Rates of contraction and relaxation were not different between the two groups.The results suggest a significant change in the length-tension relationship of the PF muscles after SCI, but no change in the DF muscle group. Rehabilitation programs should focus on maintaining PF muscle length in order to optimize muscle strength and function after SCI.

2-amino-5-phosphonovaleric acid (APV) is an N-methyl-D-aspartate (NMDA) receptor blocker and has neuroprotective properties. This study is aimed at evaluating the effect of APV treatment on oxidative status after spinal cord injury (SCI).The experiment was carried out on the following five groups: Group 1: sham operated, non-traumatized; Group 2: with injured spinal cord, no treatment; Group 3: with SCI, injected with 100 microg kg(-1) APV; Group 4: with SCI, injected with 200 microg kg(-1) APV; and Group 5: with SCI, injected with 400 microg kg(-1) APV. SCI was inflicted by epidural compression with a cerebral vascular clip after T9-11 laminectomy. The experiments were completed after 12 h of trauma. Spinal cords were excised for evaluation of superoxide dismutase (SOD), catalase, reduced glutathione (GSH) and malonyldialdehyde (MDA) levels.After SCI, SOD and GSH levels decreased and the MDA level increased significantly. APV treatment decreased the MDA level and increased SOD, catalase and GSH levels. The maximum decrease in MDA was detected in the group treated with 100 microg kg(-1) APV compared with the other groups. The GSH level was significantly increased in the group treated with 200 microg kg(-1) APV. The SOD level was significantly increased in the group treated with 200 microg kg(-1) APV.The results of this study have shown that APV treatment creates a dose-dependent antioxidant effect in rats with SCI and may be used for the treatment of SCIs.

Prospective data collection.To evaluate occurrence and characteristics of candiduria in a population of individuals with spinal cord injury (SCI) or multiple sclerosis (MS) and chronic catheter usage. Candiduria, or presence of Candida species in the urine, is a common clinical problem. It is most frequently seen in patients with indwelling urinary catheters. Many patients have these catheters in place chronically. Previous studies have shown that despite therapy, most patients with candiduria will develop the infection again and that complications such as invasive candidiasis are rare. However, there are no studies that specifically examine the role of candiduria in patients with SCI and long-term catheter use.Inpatients and outpatients in a US Veterans Affairs spinal cord injury center.Urinalysis, culture, patient demographic and clinical characteristics through chart review.Of 100 total patients, 52 had paraplegia, 45 tetraplegia and 3 MS. Overall, 17 (17%) patients had candiduria, which was observed in urine culture. Antibiotic use was associated with an increased risk of developing candiduria. Indwelling catheter (urethral or suprapubic) usage was also significantly associated with candiduria; only one person on intermittent catheterization developed candiduria, which was not associated with adverse clinical outcomes.Antibiotic usage and indwelling catheterization were associated with candiduria. No participant in our study population developed invasive candidiasis, and persistence of candiduria was not frequent.

Résumé Les réactions sexuelles sont sous contrôle neurologique. Le traumatisme vertébromédullaire altère l’organisation neurologique et génère un dysfonctionnement sexuel. Les substances pharmacologiques actuelles permettent de rétablir la fonction érectile du blessé médullaire, première étape essentielle à la réorganisation d’une vie sexuelle. Le déclenchement de l’éjaculation est souvent difficile. Les techniques de stimulation périnéale isolées ou associées au traitement pharmacologique favorisent la réalisation d’éjaculation et permettent un recueil et une conservation du sperme. La possibilité d’obtenir une éjaculation au cours des rapports sexuels, chez le blessé médullaire, reste rare et sans véritable solution thérapeutique. Malgré l’altération de la qualité du sperme, les blessés médullaires conservent une possibilité de procréation pour 40 à 60 % des couples. Le recours à des techniques d’assistance médicale à la procréation est souvent nécessaire. La prise en charge des dysfonctionnements sexuels des blessés médullaires doit être intégrée dans un programme de rééducation et de réinsertion.

The specific effects of resistance and endurance training on upper extremity work capacity, muscular strength, and anaerobic power in chronic survivors of paraplegia have not been previously determined.This study compared the effects of 12 wk of endurance training (ET) with 12 wk of resistance training (RT) on VO(2peak), upper extremity strength, and power output in persons with chronic paraplegia.Eighteen subjects with neurologically complete paraplegia, T6-T10, participated in three weekly exercise sessions during a 12-wk training period. Subjects were matched into pairs (body mass and gender) and were randomly assigned to ET or RT. The ET group performed 30 min of arm cranking at 70%-85% of HR(peak). The RT group performed three sets of 10 repetitions at six exercise stations with an intensity of ranging from 60% to 70% of 1 repetition maximum (1RM). Values of upper extremity strength (1RM) were established using the Mayhew regression equation. VO(2peak) was determined during arm ergometry testing using open circuit spirometry. Arm Wingate anaerobic testing (WAnT) was used to determine subjects' peak and mean anaerobic power output.VO(2peak) values were significantly greater after RT (15.1%) and ET (11.8%). Muscular strength significantly increased for all exercise maneuvers in the RT group (P values0.01) with no changes detected in the ET group. Mean WAnT power increased in the RT and ET groups by 8% and 5%, respectively. The RT group displayed significantly greater gains in peak WAnT power (P0.001) than ET, 15.6% and 2.6%, respectively.Persons with paraplegia can significantly improve their upper extremity work capacity, muscular strength, and power by participating in RT.

Cross-sectional observational study.Acute-care unit and tertiary rehabilitation centre in Ontario, Canada.To evaluate attitudes towards older patients among nurses caring for individuals with spinal cord injury (SCI), and examine potential determinants of ageist attitudes.Using Kogan's Old People Scale, this questionnaire-based survey assesses attitudes towards older patients among registered nurses working in an acute-care unit, registered nurses working in a rehabilitation centre and individuals with chronic SCI.Although individuals with SCI and nurses working in the rehabilitation setting were statistically comparable regarding their attitudes towards older patients, nurses working in the acute-care unit hold more ageist attitudes than their rehabilitation-nursing counterparts (P=0.003). Among nurses, a higher level of education and working in the rehabilitation setting were associated with fewer ageist attitudes (P0.03). There was a trend for an association between older age and more positive attitudes towards older patients (P=0.069).Our questionnaire-based survey, which appears to represent the population of interest, identified significant differences in the attitudes towards older patients between nurses working in the acute-care setting versus rehabilitation setting who showed similar attitudes towards individuals with SCI. The most reliable factor associated with the nurses' attitudes was their level of education. Given that the practice of ageism has the potential to prejudice service provision and ultimately recovery of patients with SCI, further research and knowledge dissemination activities for nurses caring for elderly patients with SCI should be sought.

To describe the prevalence and knowledge of autonomic dysreflexia (AD) from patient and caregiver perspectives, and its relationship to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) classification, level of injury, severity of injury, injury etiology, gender and race.Participants were between 1 and 21 years old. Demographic information was collected from the medical records, and patients and caregivers were interviewed with the following questions: (1) Does the patient experience AD? (2) Does the patient/caregiver know what AD is? (3) Can the patient/caregiver name three signs/symptoms of an AD episode? (4) Does the patient/caregiver know how to treat AD?Overall, 40% of patients and 44% of caregivers said that the patient was symptomatic for AD. AD was more common in those with traumatic etiologies, in patients with injuries at or above T6 and those with greater injury severity as measured by the AIS. For patients and caregivers, AD was less common in the youngest age group (0-5 years old). Patients with greater knowledge of AD were more likely to have traumatic etiologies, have T6 or higher injuries, be in the oldest age at injury group, be older at time of examination and have had a shorter duration of injury.AD seems to be more common in patients with traumatic injuries, older ages at injury, greater injury severity on the AIS and level of injury at or above T6.

The regenerative potential of the adult central nervous system (CNS) is limited, contributing to poor recovery from neurological insult. Many genes have been identified that promote neural regeneration, but the current viral methods used to mediate neural gene transfer have a range of drawbacks, notably safety. Non-viral magnetic nanoparticle (MNP)-based vector systems offer significant advantages over viral systems, including: (a) safety; (b) flexibility of functionalization with genetic material; (c) potential for non-invasive magnetic targeting; and (d) imaging potential. The applications of such a system to promote intrinsic neural regeneration have not been assessed. We examined uptake of intravenously administered MNPs (diameter, 320 nm) into areas of experimental rodent spinal cord injury (SCI), using a transection model. We found focal uptake of MNPs in areas of SCI associated with breakdown of the blood–brain barrier (BBB) within 6 h of injury; a spatial association was observed between MNPs and nuclei in lesions, suggesting that particle uptake was occurring in cells within injury sites. Our data suggest that there may be a ‘therapeutic window of opportunity’ during post-injury BBB compromise within which MNPs can be used to mediate gene transfer to sites of spinal cord trauma. Taking into account the relatively superficial anatomical location of the spinal cord, these findings also raise the possibility that the spinal cord could be an attractive target for MNP-based delivery of biomolecules, particularly when combined with magnetic targeting strategies. We discuss factors that will need to be addressed in order to optimize such an approach. Copyright © 2008 John Wiley & Sons, Ltd.

Bone mineral density (BMD) of the lumbar spine (L-spine) has been reported to be normal or increased in persons with chronic spinal cord injury (SCI).To determine BMD of the L-spine by dual-energy X-ray absorptiometry (DXA) and quantitative computerized tomography (qCT) in men with chronic SCI compared with able-bodied controls.Cross-sectional, comparative study.Clinical research unit, Veterans Affairs Medical Center, Bronx, NY, USA and Kessler Institute of Rehabilitation, West Orange, NJ, USA.Measurements of the L-spine were made in 20 men with SCI and compared with 15 able-bodied controls. The DXA images were acquired on a GE Lunar DPX-IQ. The qCT images of the L-spine were acquired on a Picker Q series computerized tomographic scanner.The mean ages for the SCI and control groups were 44+/-13 vs 42+/-9 years, and the duration of injury of the group with SCI was 14+/-11 years. There were no significant differences between the SCI and control groups for L-spine DXA BMD (1.391+/-0.210 vs 1.315+/-0.178 g/m(2)) or for L-spine DXA T-score (1.471+/-1.794 vs 0.782+/-1.481). L-spine qCT BMD was significantly lower in the SCI compared with the control group (1.296+/-0.416 vs 1.572+/-0.382 g/m(2), P=0.05); the T-score approached significance (-1.838+/-1.366 vs -0.963+/-1.227, P=0.059). Subjects with moderate degenerative joint disease (DJD) had significantly higher T-scores by DXA than those without or with mild DJD.Individuals with SCI who have moderate to severe DJD may have bone loss of the L-spine that may be underestimated by DXA, reducing awareness of the risk of fracture.

Study Design Non-randomized pilot trial Objectives Determine whether Escherichia coli 83972-coated urinary catheters in persons with spinal cord injury (SCI) practicing an intermittent catheterization program (ICP) could (1) achieve bladder colonization with this benign organism, and (2) decrease the rate of symptomatic urinary tract infection (UTI). Setting Outpatient SCI clinic in a Veterans Affairs hospital (USA) Methods Participants had neurogenic bladders secondary to SCI, were practicing ICP, had experienced at least 1 UTI, and had documented bacteruria within the past year. All subjects received a urinary catheter that had been pre-inoculated with E. coli 83972. The catheter was left in place for 3 days then removed. Subjects were followed with urine cultures and telephone calls weekly for 28 days and then monthly until E. coli 83972 was lost from the urine. Outcome measures were (1) the rate of successful bladder colonization, defined as the detection (≥102 cfu/ml) of E. coli 83972 in urine cultures for > 3 days after catheter removal and (2) the rate of symptomatic UTI while colonized with E. coli 83972. Results Thirteen subjects underwent 19 insertions of study catheters. Eight subjects (62%) became successfully colonized for > 3 days after catheter removal. In these 8 subjects, the rate of UTI while colonized was 0.77 per patient-year, in comparison to the rate of 2.27 UTI per patient-year prior to enrollment. Conclusions E. coli 83972-coated urinary catheters are a viable means to achieve bladder colonization with this potentially protective strain in persons practicing ICP.