Showing papers in "Journal of Spinal Cord Medicine in 2003"
TL;DR: The International Standards for Neurological Classification of Spinal Cord Injury (ISC-II) as mentioned in this paper is a set of international standards for the classification of spinal cord injury that were developed by the International Association of Neurological Diseases and Pathology (IANS).
Abstract: (2003). International Standards For Neurological Classification Of Spinal Cord Injury. The Journal of Spinal Cord Medicine: Vol. 26, No. sup1, pp. S50-S56.
1,931 citations
TL;DR: Intravesical RTX administration, in general, is a well-tolerated new therapy for DH, yet some patients responded with significant improvement in bladder capacity and continence function shortly after RTX administration.
Abstract: Objective: Resiniferatoxin (RTX) is an analogue of capsaicin with more than 1,000 times its potency in desensitizing C-fiber bladder afferent neurons. This study investigated the safety and efficacy of intravesical RTX in patients with refractory detrusor hyperreflexia (DH).Methods: Thirty-six (22 males, 14 females) neurologically impaired patients (20 spinal cord injury, 7 multiple sclerosis, 9 other neurologic diseases) with urodynamically verified DH and intractable urinary symptoms despite previous anticholinergic drug use were treated prospectively with intravesical RTX using dose escalation in a double-blind fashion at 4 centers. Patients received a single instillation of 100 ml of placebo (n = 8 patients) or 0.005, 0.025, 0.05 , 0.10 , 0.2, 0.5, or 1.0 fLM of RTX (n = 4 each group). A visual analog pain scale (VAPS) (0-10; 10 = highest level of pain) was used to quantify discomfort of application. Treatment effect was monitored using a bladder diary and cystometric bladder capacity at weeks...
83 citations
TL;DR: Gross hematuria in individuals with SCI warrants aggressive assessment for bladder cancer, and chronic indwelling catheter, smoking, and renal and bladder stones are important risk factors for cancer.
Abstract: Objective The incidence of bladder cancer in spinal cord injury (SCI) is 16 to 28 times higher than that in the general population. The objective of this study was to investigate the characteristics of bladder cancer that are unique to the SCI population. Design Retrospective review. Methods The charts of 16 patients diagnosed with bladder cancer from 1982 to 2001 were reviewed for type of cancer, exposure to risk factors, presenting symptoms, and survival time. Results The presenting manifestations were gross hematuria in 14 patients, papillary urethral growth in 1 patient, and acute obstructive renal failure in 1 patient. The diagnosis was made on initial cystoscopic evaluation in 16 patients; 3 patients required further evaluation. Eight of the 11 screening cytologies were suspicious for a malignancy prior to the diagnosis. Seven patients had transitional cell carcinoma, 6 patients had squamous cell carcinoma (SCCA), and 3 patients had both. The bladder wasmanaged with chronic indwelling catheter in 12 patients. Nine patients died of bladder cancer metastases and the remaining 3 patients died of other causes. Six patients survived 5 years or more; 4 were still alive at the completion of this study. Conclusion Gross hematuria in individuals with SCI warrants aggressive assessment for bladder cancer. Chronic indwelling catheter, smoking, and renal and bladder stones are important risk factors for cancer. The incidence of SCCA in the SCI popullation is much higher than in the general population. Cystoscopic and cytologic evaluation in patients with advanced disease may fail to confirm the diagnosis in a high proportion of patients.
74 citations
TL;DR: This retrospective study suggests that the Lyndhurst Center Central Neuropathic Pain Acupuncture Protocol may be an effective treatment option for patients with SCI who are experiencing below-level central neuropathic pain.
Abstract: Background/Objective: Below-level central neuropathic pain, a diffuse pain characterized by generalized burning, is commonly experienced by individuals with spinal cord injury (SCI) . The objective of this study was to investigate the effects of an electroacupuncture protocol for the treatment of below-level central neuropathic pain developed at the Toronto Rehabilitation Institute, Lyndhurst Center, Toronto, Ontario, Canada.Method: Retrospective chart review.Results: Thirty-six individuals with traumatic and nontraumatic SCI met the inclusion criteria. Of these, 24 showed improvement after treatment with the electroacupuncture protocol. Type of injury, level of injury, and duration of below-level central neuropathic pain was not correlated with improvement. However, individuals whose pain was described as bilateral (vs unilateral; P = 0 .01 4) or symmetric (vs non symmetric; P = 0.02 6) were more likely to improve after acupuncture treatment. Overall, patients whose burning pain was bilateral, sy...
64 citations
TL;DR: To determine whether individuals with spinal cord injuries who complain of symptoms of a urinary tract infection (UTI) actually have a UTI, a 9-month prospective case review was conducted to predict the presence or absence of aUTI.
Abstract: Objective: To determine whether individuals with spinal cord injuries (SCis) who complain of symptoms of a urinary tract infection (UTI) actually have a UTI.Design: A 9-month prospective case revie...
56 citations
TL;DR: Arm WAnT is a reliable measurement tool for the assessment of upper extremity muscular power in persons with complete paraplegia and is found to be closely associated with Ppeak and Pmean between the 2 trials.
Abstract: Background: Accurate, reliable assessment of upper extremity muscular power in persons with paraplegia caused by spinal cord injury (SCI) would provide an objective indication of their ability to g...
51 citations
TL;DR: Patient and family education about AD is, therefore, increasingly important for all patients with tetraplegia, as hospital lengths of stay decrease, and patients may be discharged before onset of symptoms.
Abstract: Background: Autonomic dysreflexia (AD) is a common problem in patients with spinal cord injury (SCI) above the T6 neurologic level and may cause serious medical complications if untreated. Previous studies have focused on patients with complete SCI.Design: Prospective analysis of a historic cohort. A retrospective review of a subset of the cohort also was performed.Objectives: To examine the percentage of persons with complete and incomplete tetraplegia who developed AD and determine whether patients with incomplete injuries were at risk for developing AD; and to study the onset of AD and determine the time period that patients are at risk for developing AD.Methods: Data were collected prospectively on 332 patients with tetraplegia to determine American Spinal Injury Association (ASIA) impairment score, neurologic level, presence of AD, and length of hospital stay. The charts of 3 4 patients who developed AD were then reviewed retrospectively for further data such as onset and contributing factors...
50 citations
TL;DR: Findings provide the foundation for studying the utility of the PAPAW in reducing the risk of upper limb injury and neuropathy in the manual wheelchair user population.
Abstract: Background/Objective: The objective of this study was to examine the use and efficacy of a pushrim-activated power-assist wheelchair (PAPAW) in the reduction of upper extremity range of motion (ROM...
45 citations
TL;DR: Although the FES system was devised as a temporary means of achieving functional activation until permanent means could be achieved, it was found to be effective and relatively safe for more than 17 years and has the potential for short-term rehabilitation in individuals with incomplete paraplegia or stroke.
Abstract: Objective: To assess the safety and effectiveness of long-term use of functional electrical stimulation (FES) for exercise, standing, and walking in individuals with paraplegia, using percutaneous ...
42 citations
TL;DR: An overview of pediatric-onset spinal cord injury is provided, emphasizing unique clinical and epidemiologic features, pathophysiology, medical and musculoskeletal complications, and psychosocial and management issues.
Abstract: This introductory review provides an overview of pediatric-onset spinal cord injury, emphasizing unique clinical and epidemiologic features, pathophysiology, medical and musculoskeletal complications, and psychosocial and management issues. Developmental factors influence the approach to bowel and bladder programs, mobility, patient education, and management of complications. Rehabilitation goals must be set for each developmental stage, with the final goal being that of a satisfying and productive adult life.
41 citations
TL;DR: Oxybutynin XL is safe and effective in patients with detrusor hyperreflexia secondary to SCI, and daily dosages up to 30 mg are well tole rated.
Abstract: Objective: This study evaluated the effects and tolerability of extended-release oxybutynin chloride on the frequency of voiding and catheterization and urodynamic capacity in spinal cord injury (SCI) patients with defined detrusor hyperreflexia.Methods: This was a 1 2-week, prospective, dose-titration study of extended-release oxybutynin (oxybutynin XL) . SCI patients with urodynamically defined detrusor hyperreflexia were recruited for this study. Following a 7 -day washout period, patients were evaluated via video-urodynamic study and then treatment was initiated at a dosage of 1 0 mg per day. Dosage was increased in weekly intervals to a maximum of 30 mg per day. Micturation frequency diaries and urodynamics were completed at baseline and repeated at week 1 2. Tolerability information was collected at each follow-up visit.Results: Ten patients (mean age = 49 years) with complete or incomplete SCI were enrolled. Participants reported clinical improvement (decreased urinary frequency and fewer i...
TL;DR: It is demonstrated that the observed alteration of NO metabolism is primarily responsible for the associated cardiovascular deconditioning in the returning astronauts and recovering bed-ridden patients.
Abstract: Prolonged exposure to microgravity results in cardiovascular deconditioning which is marked by orthostatic intolerance in the returning astronauts and recovering bed-ridden patients. Recent studies conducted in our laboratories at University of California, Irvine have revealed marked elevation of nitric oxide (NO) production in the kidney, heart, brain, and systemic arteries coupled with significant reduction of NO production in the cerebral arteries of microgravity-adapted animals. We have further demonstrated that the observed alteration of NO metabolism is primarily responsible for the associated cardiovascular deconditioning. Recovery from acute spinal cord injury (SCI) is frequently complicated by orthostatic intolerance that is due to the combined effects of the disruption of efferent sympathetic pathway and cardiovascular deconditioning occasioned by prolonged confinement to bed. In this presentation, I will review the nature of altered NO metabolism and its role in the pathogenesis of microgravity-induced cardiovascular deconditioning. The possible relevance of the new findings to orthostatic intolerance in patients with acute SCI and its potential therapeutic implications will be discussed.
TL;DR: A significant linear decline with age was found for functional independence, overall life satisfaction, perceived physical health, and overall handicap in the areas of physical independence, mobility, occupational functioning, and social integration following spinal cord injury.
Abstract: Objectives: Determine the unique effects of age across a variety of outcome domains following spinal cord injury (SCI).Design: Cross-sectional; 61 32 individuals with traumatic onset SCI in the Nat...
TL;DR: The results point to the need for a hybrid system that allows for unencumbered hip and knee joint motion for stepping without excessive anterior trunk lean, and could provide a reasonable speed in gait powered by muscle stimulation.
Abstract: Objective: The purpose of this case study was to improve stability, posture, and speed of gait in an individual with paraplegia through the application of a hybrid system including trunk-hip-knee-ankle-foot orthosis (THKAFO) with lockable joints and multichannel functional electrical stimulation (FES) with implanted electrodes.Methods: Two hybrid orthoses were implemented and evaluated on a person with complete absence of motor function and sensation below the T-9 level spinal cord injury. The first hybrid was a modified isocentric reciprocal gait orthosis (IRGO) with the knees controlled by FES, the ankles fixed at neutral, and the hips coupled with a reciprocator. The second hybrid had a THKAFO instrumented with lockable joints using wrap-spring clutches at the hips and knees (THKAFO-LJ) that provided free extension and allowed for flexion only when disengaged by solenoids. A microprocessor-controlled stimulator provided muscle stimulation and activation signals for the solenoids. These two hybr...
TL;DR: In this population of chronic SCI patients, bacteremia predominantly was caused by hospital-associated organisms, and occurred mainly in malnourished patients who required hospitalization for major unde rlying debilitating conditions, particularly pressure ulcers.
Abstract: Background: Individuals with spinal cord injury (SCI) have a lifelong increased risk of systemic infection, which may be associated with episodes of life-threatening bacteremia. Information concerning specific organisms causing bacteremia, the sites of primary infection, and clinical predictors for mortality are necessary to provide optimal treatment.Methods: A retrospective review of positive blood cultures collected over a 3 2-month period in chronic SCI patients treated at the Veterans Affairs Medical Center SCI Unit.Results: One hundred and twenty-three episodes of bacteremia occurred in 63 patients during 83 hospitalizations; 30 patients had multiple episodes of bacteremia. There were 1 ,644 admissions during this period, yielding an incidence of bacteremia of 7 .5% (5.8% after excluding positive cultures that were believed to be caused by contaminants). The patients (31 with paraplegia and 32 with quadriplegia) had a mean age of 59 ± 2 years, and a mean duration of injury of 23 ± 2 years. Bl...
TL;DR: The posture adopted by wheelchair users is a more important influence on UE reach than are the cushion or backrest height used, and clinicians should monitor posture while assessing seating and function of wheelchair users.
Abstract: Background: Seated posture and trunk control are important factors affecting upper extremity (UE) function of wheelchair users. A stable pelvis and trunk are required to provide a base from which U...
TL;DR: Standing with FES requires significantly more energy than does AS and may provide a cardiorespiratory stress sufficient to meet minimal requirements for exercise conditioning.
Abstract: Background: Systems of functional electrical stimulation (FES) have been demonstrated to enable some persons with paraplegia to stand and ambulate limited distances. However, the energy costs and a...
TL;DR: Although the halo is an effective form of cervical immobilization, complications with its use are encountered periodically and familiarity with the design rationale, proper method of application, and potential complications can help to minimize the morbidity of this commonly used device.
Abstract: Background The halo skeletal device commonly is used both as primary treatment and as an adjunct to internal fixation in patients with cervical spinal injuries. For optimal outcome, the multidisciplinary team should have a basic understanding of the indications, design rationale, and complications associated with the halo skeletal fixator. Design Literature review. Findings The halo device provides the most rigid form of external cervical immobilization. Adherence to established application guidelines is critical to minimize morbidity. Safe zones for pin placement have been delineated. Protocols for management of pin-site infections have been established to appropriately manage these unfortunate complications. Conclusion Although the halo is an effective form of cervical immobilization, complications with its use are encountered periodically. Familiarity with the design rationale, proper method of application, and potential complications can help to minimize the morbidity of this commonly used device.
TL;DR: Voluntary strength improved in 12 out of 13 stimulated muscles and FES was able to achieve selective stimulation of key weakened muscles for augmented walking, suggesting that FES had both direct and carryover effects.
Abstract: Background/Objective: This study evaluated the effects of functional electrical stimulation (FES) applied to the muscles acting on the pelvis, hip, and knee on muscle strength, energy cost of walking, maximum walking distance and speed, step length and cadence, and joint kinematics during gait in 3 ambulatory adolescents with incomplete spinal cord injury (SCI)Methods: Percutaneous FES was used to strengthen weakened muscles and to augment walking After training, participants walked as desired at home with FES for 1 year Data were collected at baseline (preintervention), and with FES on and FES off immediately following the training period and with FES on and FES off at 3, 6, and 12 months posttrainingResults: Voluntary strength improved in 12 out of 13 stimulated muscles Decreased energy cost, increased maximum walking distance and speed, increased step length, and improved joint kinematics during gait were demonstrated with FES on and FES off Discussion: FES was able to achieve selective st
TL;DR: The INDEPENDENCE 3000 IBOT Transporter is a functional mobility device that expands the options of wheelchair users and is most useful outdoors and where there is sufficient space to use its unique Balance function.
Abstract: Background: The INDEPENDENCE 3000 IBOT Transporter (IBOT) is an electronically stabilizing mobility device for people with disabilities. It operates in 4 functions: Standard, Balance (raised on 2 rear wheels), 4 Wheel (for inclines, curbs, and uneven terrain), and Remote (for loading into a vehicle).Objective: The purpose of this study was to observe the IBOT at use in the home and in the community.Methods: Data were obtained via observations by trained clinicians, data recorded from a computerized data logger, and reports from each expert.Participants: Participants included 10 unimpaired nonwheelchair users (6 men, 4 women) and 4 expert wheelchair users (men with spinal cord injuries, T7-L1). The participants used the IBOT to perform a variety of activities, including holding eye-level discussions with colleagues and shopping by balancing on 2 wheels, going up and down steep ramps, traversing outdoor surfaces (eg, grass, dirt trails), and climbing curbs.Observations: The Balance and 4-Wheel funct...
TL;DR: Smokers with SCI appeared to be at excessive risk for obstructive lung diseases, and smoking cessation appeared to reduce the risk substantially.
Abstract: Background: Persons with higher-level spinal cord injury (SCI) have reduced vital capacity and increased risk of respiratory symptoms and illness, with smokers experiencing excess vital capacity losses. To date, obstructive lung dysfunction, the most prominent effect of smoking in the able-bodied population, has not been characterized in persons with SCI.Objective: To determine whether smokers and/or nonsmokers with SCI are at increased risk to develop obstructive lung dysfunction, as measured by the ratio of forced expired volume in 1 second to forced vital capacity (FEY1/FVC).Methods: Regression analyses on cross-sectional data from routine clinical testing of outpatients followed at the Bronx Veterans Affairs Medical Center in metropolitan New York (NY) and Rancho Los Amigos National Rehabilitation Center in metropolitan Los Angeles (LA) tested the relationship of FEY 1 /FVC (percentage of predicted normal value) to age, SCI characteristics, and smoking status.Results: NY current smokers showed...
TL;DR: In this article, the influence of spinal cord lesion level on shoulder muscle activity during a depression raise maneuver was investigated for persons with spinal cord injury (SCI) to relieve skin pressure and avoid skin ulceration.
Abstract: Background & objective The depression-style raise maneuver is commonly performed by persons with spinal cord injury (SCI) to relieve skin pressures and avoid skin ulceration. The demands of this critical activity, however, are not fully documented for individuals with higher spinal cord lesions. The purpose of this investigation was to determine the influence of SCI lesion level on shoulder muscle activity during a depression raise maneuver. Experimental design Sample of convenience, group comparison. Methods Fine-wire intramuscular electrodes recorded electromyographic (EMG) activity from 12 shoulder muscles in 57 men with SCI while they performed depression raises (C6 tetraplegia, n = 10; C7 tetraplegia, n = 18; high paraplegia, n = 16; low paraplegia, n = 13). EMG intensity was normalized to a manual muscle test (MMT) effort. Results For persons with paraplegia and C7 tetraplegia, dominant EMG activity was recorded from latissimus dorsi, sternal pectoralis major, and triceps muscles (31%-69% MMT). Tetraplegic groups had significantly greater anterior deltoid activity (C6 = 53%, C7 = 22% MMT) than that recorded in paraplegic groups (high paraplegia = 10%, low paraplegia = 3% MMT). Participants with tetraplegia also had increased infraspinatus activity (C6 = 50%, C7 = 32% MMT) compared with participants with low paraplegia (7% MMT). All other muscles had low or very low EMG activity during the depression raise. Conclusions Persons with tetraplegia lack normal strength of the primary muscles used by participants with paraplegia for the depression raise (ie, latissimus dorsi, sternal pectoralis major, and triceps muscles). Although increased anterior deltoid activation assisted with elbow extension, it potentially contributes to glenohumeral joint impingement. Alternate methods of pressure relief should be considered for persons with tetraplegia.
TL;DR: Duplex ultrasound is an effective and valuable tool that assists in the diagnosis of asymptomatic DVT in patients with traumatic SCI who are initiating in -patient rehabilitation and DVT prophylaxis with low-molecular-weight heparin was found to be more effective than was adjusted-dose hepar in preventing thromboembolic phenomenon.
Abstract: Objective: To determine the prevalence of deep vein thrombosis (DVT) by surveillance duplex ultrasound in the traumatic spinal cord injury (SCI) population on admission to rehabilitation.De...
TL;DR: The National Institutes of Health has concluded that the potential value of acupuncture justifies expanding its use into conventional medicine and studying it further, and acupuncture shows promise as an intervention in the treatment of SCI-related conditions.
Abstract: Background: The National Institutes of Health has concluded that the potential value of acupuncture justifies expanding its use into conventional medicine and studying it further.Methods: Literature review of acupuncture as it pertains to spinal cord medicine.Results: Acupuncture has been used to treat a number of spinal cord injury (SCI)-related conditions, including motor deficits, pain, spasticity, and syringomyelia.Conclusion: Acupuncture shows promise as an intervention in the treatment of SCI-related conditions. Further research, carried out in careful and systematic fashion by qualified practitioners of acupuncture in concert with spinal cord medicine specialists, is needed.Spinal Cord Med. 2003;26:12-20
TL;DR: Use of low-cost mailed reminders and educational materials resulted in significantly higher vaccination rates for veterans with SCI, and further efforts to reach targeted subgroups of nonrecipients, such as patients who are younger or from an ethnic minority, are warranted.
Abstract: Background/Objective: Respiratory complications are the leading cause of morbidity and mortality among individuals with spinal cord injury (SCI). Influenza vaccination is effective in reducing the likelihood of contracting influenza and of subsequent respiratory complications, hospitalizations, and deaths. Historically, vaccination rates for veterans with SCI treated in Veterans Affairs (VA) facilities have been low. The objective of this study was to increase vaccination rates in this population using a multi pronged strategy.Methods: A quasi-experimental design involving 2,2 84 veterans treated at 8 VA SCI Centers was used. Patients at 4 centers received reminder letters and educational materials tailored to SCI. Provider education included mailed reminders and posters in SCI clinical areas. Clinical champions were identified at each site. Four other centers, matched to the study sites in program size and prior vaccination rates, served as comparison sites providing usual care. Vaccination rates...
TL;DR: Elevated serum creatine kinase may be associated with a more aggressive course of HO as well as resistance to etidronate therapy, and further studies are needed to determine whether creatine Kinase may serve as a marker for early, active HO.
Abstract: Background: Heterotopic ossification (HO) is a complication of spinal cord injury (SCI) characterized by formation of ectopic bone. Early diagnosis is critical, but available diagnostic methods have drawbacks. Serum creatine kinase may be a marker for the development and severity of HO.Participants: 1 8 SCI patients with diagnosed HO based on clinical findings and bone scintigraphy.Methods: Serum creatine kinase levels were taken at the time of diagnosis of HO and during subsequent etidronate therapy.Results: Of the 1 4 patients with normal creatine kinase values, 1 3 had no evidence of HO on follow-up radiographic examination. Of the 4 patients with elevated creatine kinase, all developed radiographic signs of HO.Conclusion: Elevated serum creatine kinase may be associated with a more aggressive course of HO as well as resistance to etidronate therapy. Further studies are needed to determine whether creatine kinase may serve as a marker for early, active HO.
TL;DR: The severity and permanence of this patient’s deficits were greater than those reported in the majority of previous cases of transverse myelitis due to Lyme disease alone, suggesting a possible role for coinfection with babesiosis.
Abstract: Objective: To describe transverse myelitis secondary to coexistent Lyme disease and babesiosis.Method: Case report.Background: A 7 4-year-old man presented with rapid onset of weakness, numbness, a...
TL;DR: Deep pressure ulcers overlying the spine should be managed aggressively to avoid life-threatening complications and Imaging studies are diagnostic of pneumocephalus and surgical closure of the spinal fluid leak is imperative when meningeal or other adverse neurologic signs are present.
Abstract: Background: Pneumocephalus is a well-known condition following head trauma, but is uncommon in injuries or surgeries of the spine. Even more unusual is its occurrence in association with an eroding...
TL;DR: Bladder cancer survivors were less likely to have multiple genitourinary risk factors and fewer screening cystoscopies and biopsies were performed than in those who died of bladder cancer.
Abstract: Objective: The purpose of this study was to evaluate factors influencing survival in individuals with spinal cord injury (SCI) and bladder cancer. We hypothesized that bladder cancer survivors woul...
TL;DR: In general, predisposing factors and outcomes were similar between those with SEA and those with TSCI, except for drug use and rate of pressure ulcers, and these factors do not appear to relate to differential outcome in discharge placement.
Abstract: Objective: To evaluate the course, complications, and outcomes of individuals with spinal epidural abscess (SEA) and to compare these factors in individuals who had sustained a traumatic spinal cor...