Showing papers in "Journal of Spinal Cord Medicine in 2006"
TL;DR: This study shows that olfactory mucosa autograft transplantation into the human injured spinal cord is feasible, relatively safe, and potentially beneficial.
Abstract: Background/Objective: Olfactory mucosa is a readily accessible source of olfactory ensheathing and stem-like progenitor cells for neural repair. To determine the safety and feasibility of transplanting olfactory mucosa autografts into patients with traumatically injured spinal cords, a human pilot clinical study was conducted.Methods: Seven patients ranging from 18 to 32 years of age (American Spinal Injury Association [ASIA] class A) were treated at 6 months to 6.5 years after injury. Olfactory mucosa autografts were transplanted into lesions ranging from 1 to 6 cm that were present at C4-T6 neurological levels. Operations were performed from July 2001 through March 2003. Magnetic resonance imaging (MRI), electromyography (EMG), and ASIA neurological and otolaryngological evaluations were performed before and after surgery.Results: MRI studies revealed moderate to complete filling of the lesion sites. Two patients reported return of sensation in their bladders, and one of these patients regained ...
328 citations
TL;DR: A number of interventions, including standing, electrically stimulated cycling or resistance training, and walking exercises have been explored with the aim of reducing bone loss and/or increasing bone mass and muscle mass in individuals with spinal cord injury as mentioned in this paper.
Abstract: Individuals with spinal cord injury (SCI) often experience bone loss and muscle atrophy Muscle atrophy can result in reduced metabolic rate and increase the risk of metabolic disorders Sublesional osteoporosis predisposes individuals with SCI to an increased risk of low-trauma fracture Fractures in people with SCI have been reported during transfers from bed to chair, and while being turned in bed The bone loss and muscle atrophy that occur after SCI are substantial and may be influenced by factors such as completeness of injury or time postinjury A number of interventions, including standing, electrically stimulated cycling or resistance training, and walking exercises have been explored with the aim of reducing bone loss and/or increasing bone mass and muscle mass in individuals with SCI Exercise with electrical stimulation appears to increase muscle mass and/or prevent atrophy, but studies investigating its effect on bone are conflicting Several methodological limitations in exercise studies with individuals with SCI to date limit our ability to confirm the utility of exercise for improving skeletal status The impact of standing or walking exercises on muscle and bone has not been well established Future research should carefully consider the study design, skeletal measurement sites, and the measurement techniques used in order to facilitate sound conclusions
305 citations
TL;DR: The degree and duration of pain relief provided by specific pain treatments used by individuals with spinal cord injury (SCI) who have chronic pain were determined, and many patients are not finding adequate pain relief from commonly prescribed medications.
Abstract: Background/objective To determine the degree and duration of pain relief provided by specific pain treatments used by individuals with spinal cord injury (SCI) who have chronic pain. Design Postal survey. Setting Community. Participants Participants were 117 individuals who had traumatic SCI, were 18 years of age or older, and reported a chronic pain problem. Main outcome measures Questions assessing current or past use of 26 different pain treatments, the amount of relief each treatment provided, and the length of time that any pain relief usually lasts. Results The medications tried most often were nonsteroidal anti-inflammatory drugs (tried by 71%) and acetaminophen (tried by 70%); these medications were still being used by more than one half of the patients who had tried them. Opioids produced the greatest degree of pain relief on average (mean, 6.27 +/- 3.05 [SD] on a 0-10 scale, with 0 = no relief and 10 = complete relief) but were unlikely to be continued by those who tried them. Although 38% of respondents with pain had tried gabapentin, only 17% were still using it, and average pain relief was only moderate (mean, 3.32 +/- 3.03 on the 0-10 relief scale). Seventy-three percent of the respondents had tried at least 1 of 7 alternative pain treatments, and the most frequently tried were massage, marijuana, and acupuncture. The most relief was provided by massage (mean, 6.05 +/- 2.47] on the 0-10 relief scale) and marijuana (mean, 6.62 +/- 2.54 on the 0-10 relief scale). The relief from the various treatments, including most medications, tended to last only minutes or hours; however, pain relief from alternative treatments such as massage, acupuncture, and hypnosis was reported to last for days in 25% to 33% of those who tried these treatments. Conclusions Many patients are not finding adequate pain relief from commonly prescribed medications. Alternative therapies should be considered as additional treatment options in this population.
160 citations
TL;DR: Veterans with an SCI/D and diabetes reported more comorbidities, more slow-healing foot sores, and poorer quality of life than those without diabetes, and efforts to prevent diabetes and to provide early intervention in persons with SCi/D are needed.
Abstract: Background/Objective: To examine diabetes prevalence, care, complications, and characteristics of veterans with a spinal cord injury or disorder (SCI/D).Methods: A national survey of veterans with ...
132 citations
TL;DR: The data suggest that the GameCycle seems to be adequate as an exercise device to improve oxygen uptake and maximum work capability in adolescents with lower extremity disability caused by spinal cord dysfunction.
Abstract: Background/Objective: To determine whether a new upper extremity exercise device integrated with a video game (GameCycle) requires sufficient metabolic demand and effort to induce an aerobic training effect and to explore the feasibility of using this system as an exercise modality in an exercise intervention.Design: Pre-post intervention.Setting: University-based research facility.Subject Population: A referred sample of 8 adolescent subjects with spina bifida (4 girls, 15.5 ± 0.6 years; 4 boys, 1 7.5 ± 0.9 years) was recruited to participate in the project. All subjects had some level of mobility impairment that did not allow them to participate in mainstream sports available to their nondisabled peers. Five subjects used a wheelchair full time, one used a wheelchair occasionally, but walked with forearm crutches, and 2 were fully ambulatory, but had impaired gait.Main Outcome Measures: Peak oxygen uptake, maximum work output, aerobic endurance, peak heart rate, rating of perceived exertion, and...
102 citations
TL;DR: The key factors related to long-term survival were age, time since injury, neurologic level, and degree of completeness of injury; the life expectancies were modestly lower than previous estimates.
Abstract: Background/Objective: Identify factors related to long-term survival, and quantify their effect on mortality and life expectancySetting: Model spinal cord injury systems of care across the United
100 citations
TL;DR: The results suggest that many positive changes occur within the first 2 decades after SCI, followed by a period of stability in some life areas, but decline with aging in some participation and health-related aspects of life.
Abstract: Background/Objective: This longitudinal study investigated changes in life satisfaction, general health, activities, and adjustment over 3 decades among individuals with spinal cord injury (SCI).Pa...
77 citations
TL;DR: The vibrostimulation procedure induced electrocardiographic abnormalities and autonomic dysreflexia in subjects with either cervical or high thoracic SCI.
Abstract: Background/Objective: Cardiovascular abnormalities and arrhythmias are common in individuals with spinal cord injury (SCI) who are undergoing vibrostimulation for sperm retrieval The study aimed to examine cardiovascular control in men with SCI undergoing this procedureMethods: Individuals with chronic cervical (n = 8; age: 331 ± 19 years) and upper thoracic SCI (n = 5; age: 352 ± 29 years) volunteered for vibrostimulation, with continuous blood pressure (Finometer) and electrocardiographic monitoring Patients were characterized further by sympathetic skin responses (SSR) to assess descending autonomic spinal pathways and American Spinal Injury Association (ASIA) scores to assess motor and sensory pathwaysResults: All but one subject with cervical SCI were ASIA A or B and were negative for SSR in the hands and feet All subjects with upper thoracic SCI were ASIA A or B and were positive for SSR in the hands Systolic blood pressure was lower in men with cervical injury at rest Vibrostimul
72 citations
TL;DR: The likelihood of postinjury employment varies substantially among persons with SCI, and given favorable patient characteristics, worklife should be considerably higher than previous estimates.
Abstract: Objective: To develop predictive models to estimate worklife expectancy after spinal cord injury (SCI).Design: Inception cohort study.Setting: Model SCI Care Systems throughout the United States.Participants: 20,143 persons enrolled in the National Spinal Cord Injury Statistical Centerdatabase since 1973.Intervention: Not applicable.Main Outcome Measure: Postinjury employment rates and worklife expectancy.Results: Using logistic regression, we found a greater likelihood of being employed in any given year to be significantly associated with younger age, white race, higher education level, being married, having a nonviolent cause of injury, paraplegia, ASIA D injury, longer time postinjury, being employed at injury and during the previous postinjury year, higher general population employment rate, lower level of Social Security Disability Insurance benefits, and calendar years after the passage of the Americans with Disabilities Act.Conclusions: The likelihood of postinjury employment varies substa...
63 citations
TL;DR: A randomized, double-blind comparison of twice daily bladder irrigation using 1 of 3 different solutions in community-residing persons with neurogenic bladder who used indwelling catheters to evaluate efficacy in treatment of bacteriuria was generally well tolerated.
Abstract: Background/Objective:
We conducted a randomized, double-blind comparison of twice daily bladder irrigation using 1 of 3 different solutions in community-residing persons with neurogenic bladder who used indwelling catheters to evaluate efficacy in treatment of bacteriuria.
61 citations
TL;DR: The timing, distribution, and reliance upon hip angle suggest that these movement patterns reflect some elements of a central pattern generator for stepping in persons with chronic spinal cord injury.
Abstract: Background/Objective: In the course of examining spinal motor function in many hundreds of people with traumatic spinal cord injury, we encountered 6 individuals who developed involuntary and rhythmic contractions in muscles of their legs. Although there are many reports of unusual muscle activation patterns associated with different forms of myoclonus, we believe that certain aspects of the patterns seen with these 6 subjects have not been previously reported. These patterns share many features with those associated with a spinal central pattern generator for walking.Methods: Subjects in this case series had a history of chronic injury to the cervical spinal cord, resulting in either complete (ASIA A; n = 4) or incomplete (ASIA D; n = 2) quadriplegia. We used multi-channel electromyography recordings of trunk and leg muscles of each subject to document muscle activation patterns associated with different postures and as influenced by a variety of sensory stimuli.Results: Involuntary contractions ...
TL;DR: Leg arterial function seems to deteriorate at greater rates compared to the arms for individuals with SCI, and interventions to improve cardiovascular health should include measurements taken in the legs.
Abstract: Background/Objective: The purpose of the study was to determine whether arterial diameter, flow- mediated dilatation (FMD), and arterial range are affected by spinal cord injury (SCI). We assessed arm (radial) and leg (posterior-tibial) arteries that are comparable in size and function to determine whether (a) arterial function is reduced in individuals with SCI vs nondisabled subjects and (b) decrements to SCI arterial function are greater in the legs vs arms.Participants: Eighteen men with chronic (9.8 ± 6.3 years) SCI (T2 to Til; American Spinal Injury Association A) and 13 nondisabled subjects matched for age (33.1 ± 4.8 vs 29.8 ± 8.2 years old, respectively), height, and weight (BMI = 25.3 ± 5.8 vs 26.6 ± 5.5 kg/m2, respectively).Methods: Radial and posterior tibial artery B-mode ultrasound images were continuously captured to measure resting diameter, occluded diameter, and postischemic diameters. Hierarchical linear modeling accounted for the nested experimental design.Results: Individuals ...
TL;DR: In patients with ventilator-dependent tetraplegia, there are alternative methods of ventilatory support, which offer substantial benefits compared to mechanical ventilation, and potential future developments in this field are included.
Abstract: Background/Objective:
A significant fraction of patients with cervical spinal cord injury suffer from respiratory muscle paralysis and dependence on chronic mechanical ventilation. In selected patients, diaphragm pacing (DP) through electrical stimulation of the phrenic nerves provides an alternative to mechanical ventilation with significant advantages in life quality.
TL;DR: The findings suggest the need to work more diligently to promote better health outcomes among African Americans and to further investigate how socioeconomic factors and access to health care related to diminished health outcomesamong African Americans with spinal cord injury.
Abstract: Objective: The purpose of this study was to investigate heath disparities as a function of race and gender and the extent to which socioeconomic factors mediate disparities among participants with ...
TL;DR: In the setting of CMI, no correlation between the timing of surgical decompression and motor improvement was identified, and root recovery was more predictable than spinal cord and bladder recovery.
Abstract: Background/Objective: An assessment of neurological improvement after surgical intervention in the setting of traumatic conus medullaris injury (CMI).Methods: A retrospective evaluation of a cohort...
TL;DR: The hypothesis that separate scales more accurately represent motor function than a single motor scale was supported and several lines of study converge to provide strong support for the existence of 2 distinctive dimensions underlying the ASIA motor scale.
Abstract: Background/Objective: The use of the American Spinal Injury Association (ASIA) motor score as an outcome measure requires metrological study. This paper tests the hypothesis that a more accurate representation of motor function is obtained using separate upper and lower extremity scales rather than combining all 20 key muscle ratings into a single ASIA motor score.Methods: We analyzed archived data from 6,116 ASIA motor scale records extracted from the National Spinal Cord Injury Statistical Center Database.Results: The hypothesis that separate scales more accurately represent motor function than a single motor scale was supported (X2(indifference)= 2,596; df= 1; P < 0.0001). Two scales account for 87% of the variance, whereas a single scale accounts for only 82%. Lower extremity function is well represented in both solutions; however, upper extremity function is accurately represented only with the use of 2 separate scales.Conclusions: The use of components of the ASIA standards for other than cl...
TL;DR: Data indicate that 4 months of thrice-weekly BWSTT improved muscle morphology in an individual with chronic, motor-complete SCI.
Abstract: Objective: The purpose of this pilot study was to examine the effects of 4 months of thrice-weekly body weight-supported treadmill training (BWSTT) on skeletal muscle morphology in a woman (age 27 ...
TL;DR: Substantial interrater agreement was achieved in determining subtypes of pain within the Bryce/Ragnarsson SCI-PT, and the agreement was improved for categorizing within less restrictive categories.
Abstract: Background/Objective: Pain is a common secondary complication of spinal cord injury (SCI). However, the literature offers varying estimates of the numbers of persons with SCI who develop pain. The ...
TL;DR: The increase in crossed phrenic output after application of 8-OH-DPAT to the spinal cord suqgests that dorsal horn inputs, respiratory and/or nonrespiratory, may inhibitphrenic motor output, especially after SCI.
Abstract: Background/Objective:
Hemisection of the cervical spinal cord results in paralysis of the ipsilateral hemidiaphragm. Removal of sensory feedback through cervical dorsal rhizotomy activates latent respiratory motor pathways and restores hemidiaphragm function. Because systemic administration of serotonin 1A receptor (5HT1A) agonists reversed the altered breathing patterns after spinal cord injury (SCI), we predicted that 5HT1A receptor activation after SCI (C2) would activate latent crossed motor pathways. Furthermore, because 5HT1A receptors are heavily localized to dorsal horn neurons, we predicted that spinal administration of 5HT1A agonists should also activate latent motor pathways.
TL;DR: It is suggested that fevers occur commonly in patients with SCI, with respiratory and genitourinary system etiologies most commonly identified and Injury etiology and completeness of injury may comprise additional risk factors.
Abstract: Objective: To identify the incidence, etiology, and risk factors for fevers in individuals with traumatic spinal cord injury (SCI).Design: A retrospective review of the medical records of consecuti...
TL;DR: Many individuals with pediatric-onset SCI achieve successful, stable adult outcomes, and the factors associated with that success can help us improve rehabilitation for future patients.
Abstract: Background/Objective:
Cross-sectional studies have provided information about the outcomes of adults with pediatric-onset spinal cord injuries (SCIs), but there has been no information about the stability of those outcomes over time. The purpose of this study was to assess the stability of independent living, employment, and life satisfaction and to determine factors associated with stable, successful outcomes.
TL;DR: Encrustation of a catheter is highly predictive of the presence of bladder stones, and cystoscopy should be scheduled in a person undergoing aCatheter change if catheter encrustation is noted.
Abstract: Background: Bladder calculi are the second most common urological complication in those with spinal cord injury (SCI). Detection and removal of bladder stones are important to prevent possible comp...
TL;DR: Retrievable VCFs are a safe, feasible option for secondary prophylaxis of VTE in patients with SCI and should be considered in Patients with complete motor paralysis caused by lesions in the high cervical cord, with poor cardiopulmonary reserve, or with thrombus in the inferior vena cava despite anticoagulants.
Abstract: Background: Asymptomatic deep venous thrombosis (DVT) has been reported in 60% to 100% of persons with spinal cord injury (SCI). Several guidelines have been published detailing recommended...
TL;DR: All patients with SCI had lower bone mineral density values than controls, and the level and severity of SCI and spasticity did not significantly affect BMD values.
Abstract: Background/Objective: This study was performed to evaluate the bone mineral density (BMD) values in patients with spinal cord injury (SCI) and determine the effects of the level, severity, and dura...
TL;DR: Single-dose pamidronate 90 mg is effective at reducing biochemical markers of bone hyperresorption in patients with acute SCI but is associated with a greater incidence of fever compared with a 30 mg/d X 3-day dosing regimen.
Abstract: Background/Objective: To describe the biochemical and adverse effects of a convenient single 90 mg pamidronate dose in patients with acute spinal cord injury (SCI) and compare these effects with th...
TL;DR: The foreword for this text states that it is particularly geared toward residents in orthopedics and radiology, and all practitioners that commonly encounter musculoskeletal disorders should, however, have access to this informative resource.
Abstract: Technological advances in the field of medical imaging have been dramatic over the last half-decade. As such, the title of the latest edition of this classic book has been appropriately modified from Orthopedic Radiology to Orthopedic Imaging, because the subject matter goes far beyond conventional radiography.
Dr Greenspan has once again skillfully organized this text into a single volume, making it a convenient yet comprehensive resource. The initial section serves as a general introduction to orthopedic imaging, discussing the role of the orthopedic radiologist, covering the various imaging techniques currently available, and reviewing the biology of bone formation and growth. These 46 pages establish a firm foundation for the ensuing 30 chapters addressing specific musculoskeletal conditions. The second section of the book is devoted to traumatic conditions of the musculoskeletal system, and its format is particularly suited for the orthopedist-in-training. Most of the radiographs are supplemented by diagrams, which help to clarify the various fracture patterns presented. Illustrations depicting proper positioning of the patient, beam, and cartridge are vital to understanding “adequate views.” Sections on arthritides, tumors, infections, and metabolic and congenital/developmental disorders combine reproductions of the images with explanatory line drawings, making subtle findings apparent even to the untrained eye.
In addition to the more than 1,700 superb illustrations, charts and algorithms supplement the text. Each chapter concludes with a section of bulleted “Practical Points to Remember.” As a result of this style, the abundance of information flows as an easy read. The foreword for this text states that it is particularly geared toward residents in orthopedics and radiology. Physiatrists, rheumatologists, emergency physicians, and all practitioners that commonly encounter musculoskeletal disorders should, however, have access to this informative resource.
TL;DR: Urodynamic studies have variability, and knowing ranges of variability can be helpful in determining whether differences between filling trial 1 and filling trial 2 in a single study or year-to-year changes in urod dynamic studies are significant or simply the normal variability of the urodynamic study.
Abstract: Background/Objective: Urodynamic studies are conducted on a regular basis to evaluate changes in bladderfunction after spinal cord injury. Often, differences in urodynamic parameters exist from one study or one year to the next. The objective of this study was to provide reference ranges for "normal" variability in urodynamic parameters that can be considered as "no real change" from one study to the next.Design: Retrospective chart review.Methods: Fifty consecutive individuals with spinal cord injury had 2 trials (trial 1 and trial 2) of urodynamic studies done 5 minutes apart, and the following data were collected: maximum cystometric capacity, opening pressure, maximum detrusor pressure, volume voided, and postvoid residual. The corresponding data were compared, and the frequency distribution for the change between consecutive studies was plotted. Because there is no standard, variability ranges for 5th to 95th, 10th to 90th, and 25th to 75th percentiles were calculated to give health care prov...
TL;DR: The general objective of the “Rehabilitation Medicine Summit: Building Research Capacity” was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity.
Abstract: Summary: The general objective of the “Rehabilitation Medicine Summit: Building Research Capacity” was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were: 1) researchers; 2) research culture, environment, and infrastructure; 3) funding; 4) partnerships; and 5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to pursue the agendas outlined in this report.
TL;DR: In this paper, the effects of theophylline on pulmonary function in patients with chronic traumatic tetraplegia were assessed using a double-blind placebo-controlled crossover study.
Abstract: Background/Objectives: To assess the effects of theophylline on pulmonary function in patients with chronic traumatic tetraplegia, we conducted a double-blind placebo-controlled crossover study in ...
TL;DR: This case underscores the need to ensure that safety features are addressed as technology is applied to rehabilitation and clinical care, and the requirements announced in 2005 by the Centers for Medicare and Medicaid Services are an important step in the development of comprehensive standards.
Abstract: This issue features an interesting case report on preventable burns in an individual with tetraplegia (1). This injury was secondary to wheelchair malfunction and a lack of backup to the equipment failure. This case underscores the need to ensure that safety features are addressed as technology is applied to rehabilitation and clinical care. As wheelchairs proliferate and become more sophisticated, it is crucial that safety standards for design and use also evolve. Standards need to be comprehensive (ie, they must provide a framework to guide research and development, promote safe and efficient design, and ensure the compilation of data that supports evidence-based practice and quality assurance. The requirements announced in 2005 by the Centers for Medicare and Medicaid Services (CMS) are an important step in the development of comprehensive standards.