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Sport instills self discipline, a competitive spirit, and comradeship.Its value in promoting health, physical strength, endurance,social integration, and psychological wellbeing is of little doubt. It is not difficult to understand why sport is so important for the wellbeing of people with disability. For many years disabled people have shown an interest in sport. Although opportunities for certain types of sport were available in the past, it was not until the passage of the Disabled Persons's Employment Act in 1944 that a major initiative was taken in the United Kingdom to provide facilities to enable disabled people to overcome handicaps that arose as a consequence of their disabilities. About the same time Sir Ludwig Guttman introduced sport as an essential part of the management of patients with spinal cord damage. He described the effects of sport on the rehabilitation of people with paraplegia and tetraplegia and stressed that sporting activities enabled them to overcome boredom in hospital and also promoted development of their physical and cardiorespiratory endurance. The past five decades have seen an appreciable increase of interest in sport for disabled people not only in people with disability but also in the medical profession, sporting organisations, and the government. In 1978 the Sports Council stated that buildings to which they gave grant aid must provide facilities such as access for disabled people if they were to continue to qualify for aid. A great many sporting activities that can be used for rehabilitation and recreation have become possible for disabled people. Sport is increasingly being used as treatment complementing the conventional methods of physiotherapy. It helps to develop strength, coordination, and endurance. Some sports develop selected …

Thirty-six patients with suprasacral spinal injury were treated with intravesical local anaesthetic instillation. Eighteen of 32 patients (56%) were converted from an 'ice water positive' hyperreflexic state to an 'ice water negative' state by bupivacaine hydrochloride. Four patients treated with lignocaine hydrochloride showed no benefit. Intravesical local anaesthetic instillation is suggested as a possible treatment for selected cases of detrusor hyperreflexia in patients on intermittent catheterisation.

The initial treatment of renal calculi in 16 patients with spinal disorders is reviewed. A total of 18 kidneys in 11 patients with congenital spina bifida (SB) and 5 with spinal cord injury (SCI) were treated. The mean stone burden per kidney was 3.4 cms and 1.9 cms for the SB and SI groups respectively. Complete stone clearance was obtained in 5 of 7 open operations (71%) and in 7 of 10 cases by percutaneous nephrolithotomy (70%). One kidney received extracorporeal shock wave lithotripsy as the initial treatment. The complication rate was significantly greater in cases treated by open surgery. It is suggested that percutaneous surgery is the preferred initial treatment of renal stones in the spinal patient.

The importance of long term follow up of neurological status of patients with spinal cord injuries is well recognised. Although there is a general agreement about continued radiological surveillance of these patients, there is lack of uniformity of approach and guidelines as to how frequently such screening should be undertaken and for how long it should be continued. The present study, following analysis of clinical and radiological data of 100 sequential patients, indicates that morphological complications of urinary tract are common (63% in patients studied) and that a significant number (70-75%) develop complications within the first year following onset of spinal cord dysfunction. The development of these changes appears to be related to more than 8 weeks of presence of continous indwelling catheter during patients' initial bladder management. The study further suggests that the risk of developing demonstrat-able abnormalities after 10 years of normal radiology is very small (approximately 1%). It is, therefore, suggested that patients with spinal cord paralysis should have surveillance of urinary tract annually for 10 years and that the follow up beyond 10 years should be determined by clinical necessity rather than a fixed protocol.

Recent advances in roadside management and resuscitation techniques have resulted in an increased survival rate of people with high cervical cord injury. A few become partially or permanently ventilator dependent. Not only are these people dependent on assisted ventilation, but their speech is also compromised, along with loss of voluntary control and many other bodily functions, as they are tetraplegic. By using recent technological advancements, such as portable ventilators, phrenic nerve stimulation, environmental controls and specialised wheelchairs it has been possible to manage such patients at home. Furthermore, patients on ventilators are unable to have verbal communication. There is therefore a need for them to develop either augmentative communication or the use of alternative communication aids. Recent published reports indicate the factors other than the clinical state that may prevent such patients from taking advantage of modern advances; the main issues appear to be cost factors, community care provision and ethical considerations.

A training and monitoring system has been developed to train spinal cord injured patients to relieve pressure intermittently from ischium while sitting in wheelchairs. The system automates the training of wheelchair push-ups based on certain conditioning principles. The system reminds the patient to do a push-up of a specified duration and at specified intervals. The frequency and the duration of the push-ups are monitored providing information about performance of the patients, especially when the alarms to remind the patients are disconnected. A long-term study is in hand to assess the effectiveness of the system.

A comparison has been made of the activity of three antiseptics that are used as bladder irrigants in the treatment of urinary tract infection in catheterised patients. At the concentrations and exposure times used for bladder irrigation, phenoxyethanol (2:4% v/v) proved to be highly bactericidal against urine-grown cells of all the common urinary pathogens tested. Chlorhexidine (200 microgram/ml) was active against Escherichia coli and produced significant reductions in the viability of Klebsiella pneumoniae, Proteus mirabilis and Pseudomonas aeruginosa but failed to eradicate Providencia stuartii. Exposure to noxythiolin (2.5% v/v) for 20 min had little effect in any of the bacteria, even though all strains tested had been recorded as noxythiolin-sensitive by conventional plate sensitivity tests. Contact with noxythiolin for periods of at least 1-2 hrs was necessary before extensive bactericidal activity was detected. These results provide an explanation of the poor clinical performance of noxythiolin that we have observed.

The antibiotic policies that have been recommended in the literature for the prevention and treatment of urinary tract infections in patients with spinal cord injuries undergoing long-term intermittent catheterisation are reviewed. Current practices in spinal units in England and Wales are reported and the rational bases of these policies are considered.

Physiological data on athletes and animals has been used to design this training programme and to suggest new perspectives for training the spinal cord injured. The training routines proposed are designed to improve endurance and strength and modern weight training equipment has been modified for this purpose.

Tic douloureux involving the glossopharyngeal nerve is rare and when it does occur probably often involves the vagus nerve as well. Many cases are undoubtedly not recognized, and yet the condition responds favourably and permanently to intra cranial section of the glossopharyngeal nerve and upper fila ments of the vagus nerve. We therefore propose to review the literature, discuss our own experiences, and try to clarify the clinical syndromes that this condition presents and the surgical approach that is required.

Pituitary neoplasms in primary myxoedema are rare and previously reported cases have mostly been described as chromophobe adenomas. None of them were subjected to modern methods of study. A 26 year-old woman with untreated primary hypothyroidism developed a pituitary tumour which produced bitemporal hemianopsia. Histochemical and ultrastructural studies characterized the tumour cells as thyrotrops. The secretory granules present had a mean diameter of 110 mum and were membrane-bound and surrounded by clear halos. Many of the tumour cells were actively secreting. They had reduced numbers of granules, possessed expanded Golgi complexes, abundant rough endoplasmic reticulum and free ribosomes. Cytoplasmic microfilaments were also seen. A possible mechanism of production of this tumour is discussed.

A selective differential medium has been used to search for Providencia stuartii in sewage, sewage contaminated natural waters and the faeces and skin of a small population of healthy non-hospitalized males. Colonization of 12 male patients with long-term indwelling bladder catheters and the general environment of the spinal injury unit was also examined. Providencia stuartii was not isolated from the non-hospital samples, but colonization of the urine (two patients) faeces (five patients) and skin (eight patients) was observed. Apart from equipment that had been in contact with patients urine or skin there was no general contamination of the ward environment suggesting that colonized patients were the main reservoir of this multiply antibiotic-resistant nosocomial pathogen.

A training and monitoring system has been developed to train spinal cord injured patients to relieve pressure intermittently from ischium while sitting in wheelchairs. The system automates the training of wheelchair push-ups based on certain conditioning principles. The system reminds the patient to do a push-up of a specified duration and at specified intervals. The frequency and the duration of the push-ups are monitored providing information about performance of the patients, especially when the alarms to remind the patients are disconnected. A long-term study is in hand to assess the effectiveness of the system.

A wireless environmental controller is described. The controller can either be used by itself or with other systems. It is suggested that commercially available personal computers, for environmental control and communication, will enable the severely disabled to lead a more independent life and may provide useful mental recreation.

The ability of urinary isolates of nine species of bacteria to bind to urinary catheters has been assessed using a bioluminescence technique. The experiments revealed the particularly adherent properties of Pseudomonas aeruginosa. This organism has also been shown to be most frequently isolated from the urines of the patients undergoing indwelling catheterization. It is suggested that P. aeruginosa commonly grows on the surface of catheters in situ, and that at this site it can survive antibiotic therapy and cause apparent recurrence of infection by reinoculation of the urine once therapy has been completed.