Showing papers in "Spinal Cord in 2015"
TL;DR: An understanding of the interactions between systems, both in health and disease, and the many causes of chronic inflammation may aid in the effective future treatment of immune dysfunction and related disorders following SCI.
Abstract: Review article. The objective of this study is to provide an overview of the many factors that contribute to the chronic inflammatory state typically observed following spinal cord injury (SCI). Literature review. Not applicable. SCI is typically characterized by a low-grade inflammatory state due to a number of factors. As bidirectional communication exists between the nervous, endocrine and immune systems, damage to the spinal cord may translate into both endocrinal and immune impairment. Damage to the autonomic nervous system may induce immune dysfunction directly, through the loss of neural innervation of lymphoid organs, or indirectly by inducing endocrinal impairment. In addition, damage to the somatic nervous system and the corresponding loss of motor and sensory function increases the likelihood of developing a number of secondary health complications and metabolic disorders associated with a state of inflammation. Lastly, numerous related disorders associated with a state of chronic inflammation have been found to be at a substantially higher prevalence following SCI. Together, such factors help explain the chronic inflammatory state and immune impairment typically observed following SCI. An understanding of the interactions between systems, both in health and disease, and the many causes of chronic inflammation may aid in the effective future treatment of immune dysfunction and related disorders following SCI.
121 citations
TL;DR: Widespread use of CDEs can facilitate SCI clinical research and trial design, data sharing and retrospective analyses, and will help ensure that the data elements are updated, reviewed and broadcast as additional evidence is obtained.
Abstract: Common data elements for spinal cord injury clinical research: a National Institute for Neurological Disorders and Stroke project
83 citations
TL;DR: SCI-associated pressure ulcers are common but can be prevented in the developing world, and key targets for interventions include acute care, nurse-to-patient ratios, support surfaces and education.
Abstract: Literature review. To explore the prevalence or incidence, risk factors, and costs of pressure ulcers among individuals with spinal cord injury (SCI), specifically in the context of the developing world. To highlight important targets for intervention and research for pressure ulcer management the world over. World Bank ‘low-income’ and ‘middle-income’ countries with a gross national income per capita <$12 746. PubMed search. SCI-associated pressure ulcers are very prevalent in developing nations; however, reported prevalence and incidence numbers are highly variable. Risk factors for pressure ulcers are similar in developed and developing countries however many of the risk factors are more prevalent in developing nations. SCI-associated pressure ulcers are common but can be prevented in the developing world. Key targets for interventions include acute care, nurse-to-patient ratios, support surfaces and education.
75 citations
TL;DR: Estimation of an MCID for SCI remains elusive and if the target of a therapeutic is the injured spinal cord, it is most desirable that any improvement in neurological status be correlated with a functional (meaningful) benefit.
Abstract: This is a review article. This study discusses the following: (1) concepts and constraints for the determination of minimal clinically important difference (MCID), (2) the contrasts between MCID and minimal detectable difference (MDD), (3) MCID within the different domains of International Classification of Functioning, disability and health, (4) the roles of clinical investigators and clinical participants in defining MCID and (5) the implementation of MCID in acute versus chronic spinal cord injury (SCI) studies. The methods include narrative reviews of SCI outcomes, a 2-day meeting of the authors and statistical methods of analysis representing MDD. The data from SCI study outcomes are dependent on many elements, including the following: the level and severity of SCI, the heterogeneity within each study cohort, the therapeutic target, the nature of the therapy, any confounding influences or comorbidities, the assessment times relative to the date of injury, the outcome measurement instrument and the clinical end-point threshold used to determine a treatment effect. Even if statistically significant differences can be established, this finding does not guarantee that the experimental therapeutic provides a person living with SCI an improved capacity for functional independence and/or an increased quality of life. The MDD statistical concept describes the smallest real change in the specified outcome, beyond measurement error, and it should not be confused with the minimum threshold for demonstrating a clinical benefit or MCID. Unfortunately, MCID and MDD are not uncomplicated estimations; nevertheless, any MCID should exceed the expected MDD plus any probable spontaneous recovery. Estimation of an MCID for SCI remains elusive. In the interim, if the target of a therapeutic is the injured spinal cord, it is most desirable that any improvement in neurological status be correlated with a functional (meaningful) benefit.
72 citations
TL;DR: Tuberculous meningitis is frequently associated with disabling spinal cord and radicular complications, and available treatment options are far from satisfactory.
Abstract: To summarize the incidence and spectrum of spinal cord-related complications in patients of tuberculous meningitis. Reports from multiple countries were included. An extensive review of the literature, published in English, was carried out using Scopus, PubMed and Google Scholar databases. Tuberculous meningitis frequently affects the spinal cord and nerve roots. Initial evidence of spinal cord involvement came from post-mortem examination. Subsequent advancement in neuroimaging like conventional lumbar myelography, computed tomographic myelography and gadolinium-enhanced magnetic resonance-myelography have contributed immensely. Spinal involvement manifests in several forms, like tuberculous radiculomyelitis, spinal tuberculoma, myelitis, syringomyelia, vertebral tuberculosis and very rarely spinal tuberculous abscess. Frequently, tuberculous spinal arachnoiditis develops paradoxically. Infrequently, spinal cord involvement may even be asymptomatic. Spinal cord and spinal nerve involvement is demonstrated by diffuse enhancement of cord parenchyma, nerve roots and meninges on contrast-enhanced magnetic resonance imaging. High cerebrospinal fluid protein content is often a risk factor for arachnoiditis. The most important differential diagnosis of tuberculous arachnoiditis is meningeal carcinomatosis. Anti-tuberculosis therapy is the main stay of treatment for tuberculous meningitis. Higher doses of corticosteroids have been found effective. Surgery should be considered only when pathological confirmation is needed or there is significant spinal cord compression. The outcome in these patients has been unpredictable. Some reports observed excellent recovery and some reported unfavorable outcomes after surgical decompression and debridement. Tuberculous meningitis is frequently associated with disabling spinal cord and radicular complications. Available treatment options are far from satisfactory.
65 citations
TL;DR: Oxidative stress was commonly seen in SCi patients, which may provide useful information to augment the understanding of pathophysiology of SCI patients, however, complete understanding of the biochemical events occurring at a cellular level that influence oxidative damage is required to guide future therapeutic advances.
Abstract: Oxidative stress and antioxidative parameters in patients with spinal cord injury: implications in the pathogenesis of disease
64 citations
TL;DR: There is no evidence that the pathobiology of cord injury after SBRT is different from that after standard fractionation, and experimental biologic strategies targeting the injury response pathways hold promise in mitigating this dreaded late effect of radiation treatment.
Abstract: This is a narrative review of the literature. The objectives of this study were to review the current concepts underlying the pathobiology of radiation-induced spinal cord injury; to discuss potential biologic strategies to mitigate spinal cord injury following radiation; and to provide an update on the clinical guidelines to prevent injury in the era of image-guided stereotactic body radiotherapy (SBRT). This study was conducted in Toronto, Canada. A MEDLINE search was performed using the following terms: radiation injury; radiation myelopathy; CNS radiation injury; brain necrosis, radiation; demyelination, radiation; blood–brain barrier, radiation; white matter necrosis; and SBRT. The biologic response of the spinal cord after radiation is a continuously evolving process. Death of vascular endothelial cells and disruption of the blood–spinal cord barrier leads to a complex injury response, resulting in demyelination and tissue necrosis. At present, there is no evidence that the pathobiology of cord injury after SBRT is different from that after standard fractionation. Although permanent myelopathy has become a rare complication following conventional fractionated radiation treatment, cases of radiation myelopathy have re-emerged with the increasing role of spine stereotactic body radiation therapy and reirradiation. Experimental biologic strategies targeting the injury response pathways hold promise in mitigating this dreaded late effect of radiation treatment.
64 citations
TL;DR: SCI was associated with simple or extraarticular fractures of the distal femur and the lower leg and Fractures were mainly managed operatively with a low complication rate.
Abstract: Study design Retrospective data analysis. Objectives To document fracture characteristics, management and related complications in individuals with traumatic spinal cord injury (SCI). Setting Rehabilitation centre for SCI individuals. Method Patients' records were reviewed. Patients with traumatic SCI and extremity fractures that had occurred after SCI were included. Patient characteristics, fractured bone, fracture localisation, severity and management (operative/conservative), and fracture-related complications were extracted. Results A total of 156 long-bone fractures in 107 SCI patients (34 women and 73 men) were identified. The majority of patients were paraplegics (77.6%) and classified as American Spinal Injury Association Impairment Scale A (86.0%). Only the lower extremities were affected, whereby the femur (60.9% of all fractures) was fractured more frequently than the lower leg (39.1%). A total of 70 patients (65.4%) had one fracture, whereas 37 patients (34.6%) had two or more fractures. Simple or extraarticular fractures were most common (75.0%). Overall, 130 (83.3%) fractures were managed operatively. Approximately half of the femur fractures (48.2%) were treated with locking compression plates. In the lower leg, fractures were mainly managed with external fixation (48.8%). Conservative fracture management was applied in 16.7% of the cases and consisted of braces or a well-padded soft cast. Fracture-associated complications were present in 13.5% of the cases but did not differ significantly between operative (13.1%) and conservative (15.4%) fracture management. Conclusion SCI was associated with simple or extraarticular fractures of the distal femur and the lower leg. Fractures were mainly managed operatively with a low complication rate.
60 citations
TL;DR: The overall TSCI incidence is low and remained stable from 1990 to 2012, while age at time of injury and proportion of fall-related injuries and proportion with incomplete tetraplegia all increased.
Abstract: Study design:Hospital-based incidence study.OBJECTIVES:To assess the incidence of traumatic spinal cord injuries (TSCIs) and TSCI incidence trends in relation to cause, age, gender, level and completeness of injury.Setting:Spinal Cord Injury Centre of Western Denmark.METHODS:We reviewed medical records of TSCI patients admitted between 1 January 1990 and 31 December 2012. Proportions, incidence rates and incidence rate ratios were calculated for five time periods; 1990-94, 1995-99, 2000-04, 2005-09 and 2010-12, and were stratified on age, gender, cause, level and completeness of TSCI. TSCI incidence was calculated as the number of new cases divided by person-years at risk.RESULTS:Included were 691 patients (males 81.9%). Within the study period, median age at time of injury rose from 29.0 to 47.5 years. The overall annual TSCI incidence during the study period 1990-94 to 2010-12 was 10.2 per million person-years at risk and varied from 8.3 to 11.8. The proportion of transport-related injuries fell from 56.9% in the first to 36.8% in the most recent time period. Fall-related injuries rose from 11.1 to 35.5%. The proportion of incomplete tetraplegia increased from 32.0% in the first to 40.5% in the last time period.CONCLUSIONS:The overall TSCI incidence is low and remained stable from 1990 to 2012. The proportion of transport-related injuries fell, while age at time of injury and proportion of fall-related injuries and proportion with incomplete tetraplegia all increased.Spinal Cord advance online publication, 4 November 2014; doi:10.1038/sc.2014.181. Language: en
59 citations
TL;DR: Epidemiological factors of SCI in Indian scenario are different from western countries with major cause being fall and the low socio-economic status and younger age group had a major financial, social and psychological impact as majority of the patients were the primary earning members of the family.
Abstract: Study design:Prospective observational study.OBJECTIVES:To find out the epidemiology and demographic factors associated with patients of traumatic spinal cord injury (SCI).Setting:Sawai Man Singh Medical College and Hospital, Jaipur, India.METHODS:Consecutive SCI cases admitted from January 2000 to December 2008 were evaluated on a preformed proforma for demographic factors, epidemiological data and neurological status.RESULTS:In 2716 cases of SCI, 1400 were cervical and 1316 thoracolumbar, with male to female ratio of 4.2:1 and 71% in the age group of 20-49 years. Around 79% patients were from rural background. About 23.3% were farmers while 22.9% were laborers. Among the causes of injury, 53% patients had a fall from height and 28% suffered from road traffic accidents. Fall of heavy object over head and back (10.7%), fall with heavy object over head (3.0%) and fall following electric shock (4.0%) were uncommon causes. Complete paralysis was found in 20.5% cervical and 23.3% in thoracic injuries. Extremity and rib fractures (10.6%) and head injuries (7.2%) were common associated injuries. About 55% cases were initially attended at non-specialized centers. Proper bladder and bowel management in early phase was lacking.CONCLUSION:Epidemiological factors of SCI in Indian scenario are different from western countries with major cause being fall. The low socio-economic status and younger age group had a major financial, social and psychological impact as majority of the patients were the primary earning members of the family. Therefore, measures should be taken to reduce the incidence of SCI.Spinal Cord advance online publication, 16 September 2014; doi:10.1038/sc.2014.153. Language: en
56 citations
TL;DR: The aetiology and high mortality of TSCi in Botswana indicate that improvements in roadway safety and medical care may decrease the TSCI incidence and mortality.
Abstract: Study design:Descriptive study with a cross-sectional designOBJECTIVES:To describe the epidemiology of traumatic spinal cord injuries (TSCIs) in Botswana, with a specific focus on road traffic crashes (RTC)Setting:Main public referral hospital, Gaborone, BotswanaMETHOD:Two samples were included Sample one described the epidemiology and included patients admitted during a 2-year period with acute TSCI Sample two included only patients with TSCI due to RTCRESULTS:Annual incidence was 13 per million population Epidemiology of TSCI: 49 patients were included, 71% male, age ranging from 4 to 81 years, 80% ⩽45 years Tetraplegia was more common than paraplegia (59/41%), and 39% had C1-C4 level of injury The main cause of TSCI was RTC (68%), followed by assault (16%) and falls (10%) Mortality was 20%, where all, but one, had tetraplegia (18%) Median time from injury to spinal surgery was 12 days, with longer time for women, 16 days compared with 8 for men Burst tire was the primary cause of RTC resulting in a TSCI, followed by hitting animals on the road The majority had been passengers and 72% were involved in single crashesCONCLUSION:The most common cause for TSCI was RTC, followed by assault In-hospital mortality was high and the waiting period from the time of accident to spinal surgery was long, especially for women The aetiology and high mortality of TSCI in Botswana indicate that improvements in roadway safety and medical care may decrease the TSCI incidence and mortalitySpinal Cord advance online publication, 25 November 2014; doi:101038/sc2014203 Language: en
TL;DR: Meta-analytic results indicate a moderate effect of tDCS in reducing neuropathic pain among individuals with SCI; however, the effect was not maintained at follow-up.
Abstract: Effectiveness of transcranial direct current stimulation for the management of neuropathic pain after spinal cord injury: a meta-analysis
TL;DR: The incidence rate of TSCI in a region of South Africa was high when compared to previously postulated figures for the country, and there is a need for primary preventative strategies to target younger men that are exposed to violent activities.
Abstract: Incidence and aetiology of traumatic spinal cord injury in Cape Town, South Africa: a prospective, population-based study
TL;DR: The PAG for adults with SCI are sufficient to improve aspects of aerobic and muscular fitness and should be promoted as a means to improve physical capacity.
Abstract: Randomized controlled trial. To evaluate the effectiveness of the physical activity guidelines (PAG) for adults with spinal cord injury (SCI) to improve aspects of physical fitness. Community exercise facility. Twenty-three participants (age: 40.4±11.6 years, C1–T11, 12.0±10.0 years post injury) were randomized into PAG training (n=12) or active control (CON, n=11) groups. PAG training was 2x per week for 16 weeks and involved 20 min of aerobic exercise at a moderate to vigorous intensity and three sets of 10 repetitions (at 50–70% 1 repetition maximum; 1RM). Pre- and post-testing included peak exercise and aerobic endurance tests on an arm ergometer and 1RM testing. Nineteen participants (PAG, n=11; CON, n=8) completed the 16-week training program and post-testing. There was a significant (P<0.05) increase in peak aerobic capacity (relative VO2peak: 17.2%, absolute VO2peak: 9.9%) and submaximal power output (26.3%) in the PAG group only. Increases in strength ranged from 11.5–38.9% and were significantly (P<0.05) different from CON for vertical bench press, seated row, and rickshaw press. Adherence to the exercise program was 85.2±8.3% for PAG, 44.4±34.3% for CON (P<0.01). The PAG for adults with SCI are sufficient to improve aspects of aerobic and muscular fitness and should be promoted as a means to improve physical capacity. Ontario Neurotrauma Foundation (ONF), Natural Sciences and Engineering Research Council (NSERC) of Canada.
TL;DR: Measuring serum levels of TNF-α and IL-1β over time could be useful in tracking the course of SCI and show differences in measured cytokines over a 12-week period for SCI patients with and without neurological improvement.
Abstract: A pilot study on temporal changes in IL-1β and TNF-α serum levels after spinal cord injury: the serum level of TNF-α in acute SCI patients as a possible marker for neurological remission
TL;DR: Myelotomy improves locomotor function, reduces edema in rats with SCI and is associated with decreased expression of AQP4 and AQP9.
Abstract: Myelotomy reduces spinal cord edema and inhibits aquaporin-4 and aquaporin-9 expression in rats with spinal cord injury
TL;DR: Self-efficacy and low levels of negative mood states strongly contribute to resilience, and the determination of these predictors will assist in improving rehabilitation programs to strengthen the resilience of people with SCI.
Abstract: Factors predicting resilience in people with spinal cord injury during transition from inpatient rehabilitation to the community
TL;DR: The increased prevalence of cardiovascular disease in SCI/D patients could represent a consequence of untreated SDB, and improving diagnosis and management of SDB has the potential to improve outcomes for these patients.
Abstract: A follow up on an ongoing prospective cohort study. Spinal cord injury or disorder (SCI/D) patients have higher rates of sleep-disordered breathing (SDB) than the general population. The objectives of this study were to examine predictors of SDB diagnosis and to estimate rates of SDB treatment in SCI/D patients. A SCI clinical sleep research laboratory. Twenty-eight SCI/D patients (7 women, age 42.8±15.8 years; 16 cervical and 12 thoracic level injuries) completed a battery of questionnaires (Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Berlin questionnaire (BQ) and fatigue severity scale (FSS)) and had one night of attended laboratory polysomnography (PSG). Participants were then notified of the results of their PSG and were interviewed approximately 1 year later to assess clinical outcomes. The majority of patients reported poor sleep quality on all questionnaires. On the basis of PSG, 22 (79%) patients had SDB (apnea-hypopnea index (AHI)⩾5 events per hour), and 17 (61%) had moderate/severe SDB (AHI⩾15 events per hour). Higher ESS scores were associated with a higher risk of AHI⩾5; however, other questionnaires did not distinguish between those with and without SDB using either AHI cutoff. In follow-up interviews, only 50% of patients had spoken to a health-care provider about SDB and only six patients with SDB were prescribed treatment, four of whom were using the treatment at follow-up. SDB is common and severe among SCI/D patients. Screening questionnaires do not appear to differentiate between those with and without SDB. Even when SDB was recognized, many patients remained untreated. The increased prevalence of cardiovascular disease in SCI/D patients could represent a consequence of untreated SDB, and improving diagnosis and management of SDB has the potential to improve outcomes for these patients.
TL;DR: The most common mechanism of injury was sports-related and cervical injury, which occurred more frequently than other levels, and initial AIS grade A showed poorer outcomes in the pediatric population compared with the adult population.
Abstract: STUDY DESIGN: Systematic review. OBJECTIVES: The objective of this study is to systematically review the literature for pediatric cases of spinal cord injuries without radiologic abnormality (SCIWORA) to investigate any possible relationship between initial neurologic impairment and eventual neurologic status. SETTING: A university department of orthopedics. METHODS: Following the preferred reporting items for systemic reviews and meta-analysis (PRISMA) guidelines for systematic review, the databases of PubMed and OvidSP were electronically searched for articles that use individuals under 18 years old, have trauma resulting in spinal cord injury and have no fractures or dislocations on radiographs. When available, the patients' age, sex, mechanism of injury and spinal cord level were recorded. Individuals with cervical injury, who had specific information on cervical level and mechanism of injury, were recorded as well. Patients who reported specific magnetic resonance imaging findings and the time from the injury were also reported. When possible, the American Spinal Injury Association Impairment Scale (AIS) was determined initially after the injury and then at last follow-up. RESULTS: A total of 433 pediatric patients were identified with SCIWORA. The most prevalent mechanism of injury was sports-related injury cases (39.83%) followed by fall (24.18%) and motor vehicle-related (23.18%) injuries. The mean improvement recorded for all patients was 0.89 AIS grades. CONCLUSION: The most common mechanism of injury was sports-related and cervical injury, which occurred more frequently than other levels. Initial AIS grade A showed poorer outcomes in the pediatric population compared with the adult population. Initial presentation of D showed the highest likelihood of no permanent neurologic impairment (AIS of E).Spinal Cord advance online publication, 14 July 2015; doi:10.1038/sc.2015.110. Language: en
TL;DR: Chronic SNM cannot always resolve all the bladder and bowel symptoms secondary to spinal cord disease or injury, but combined with other treatments may help improve multiple symptoms.
Abstract: Retrospective case series. The primary aim was to assess the clinical effects of sacral neuromodulation (SNM) for neurogenic bladder and/or bowel dysfunction with multiple symptoms secondary to spinal cord disease or injury. Beijing, China. Between 2011 and 2013, 23 patients with multiple bladder and/or bowel problems secondary to spinal cord disease or injury were treated with a preliminary test SNM. If at least 50% clinical improvement occurred, then the patient underwent a permanent SNM procedure. We evaluated the patients using a bladder diary, post-void residual volume measurement and the Wexner questionnaire score for constipation before the test phase, during the test phase and after the permanent SNM. In the test phase, the rate of improvement in dysuria (29.4%) was significantly lower than urgency frequency (64.7%), urinary incontinence (69.2%) and constipation (75.0%). An implant was performed in 13 (56.5%) patients, including 4 patients who still used intermittent catheterization to exclude urine after permanent SNM because the symptom of dysuria could not be improved significantly and 1 patient who achieved ⩾50% improvement in lower urinary tract dysfunction but not in constipation. During follow-up (17.5±2.0 months), 1 patient (7.7%) failed and 1 patient had bilateral vesicoureteral reflux. Chronic SNM cannot always resolve all the bladder and bowel symptoms secondary to spinal cord disease or injury, but combined with other treatments may help improve multiple symptoms.
TL;DR: The SARS has the potential to be one of the few treatment methods targeting multiple organ dysfunctions following SCI and use of suppositories, digital evacuation and mini enema and subjects totally dependent on assistance during defecation were significantly lower after SARS.
Abstract: Study design Cross-sectional study. Objective To evaluate the long-term effect of the sacral anterior root stimulator (SARS) on neurogenic bowel dysfunction in a large, well defined spinal cord injury (SCI) cohort. Setting Department of Neuro-Urology, Bad Wildungen, Germany. Methods Subjects undergone surgery at for SARS-SDAF (sacral deafferentation) between September 1986 and July 2011 (n=587) answered a questionnaire. In total, 277 SARS subjects were available for the baseline (recall) and follow-up comparison. Results Median age was 49 years (range: 19-80), time from SCI to surgery was 10 years (range: 0-49) and from surgery to follow-up 13 (range: 1-25). Of the responders 73% used SARS for bowel emptying. On visual analog scale (VAS) ranging from 0-10 (best), satisfaction with SARS was 10. Baseline and follow-up comparison showed a decline in the median VAS score 0-10 (worst) for bowel symptoms from 6 (range: 4-8) to 4 (range: 2-6), P Conclusions The SARS has the potential to be one of the few treatment methods targeting multiple organ dysfunctions following SCI.
TL;DR: The effect of alpha-lipoic acid (ALA) supplementation on cardiovascular risk factors in men with chronic spinal cord injury: a clinical trial is studied.
Abstract: The effect of alpha-lipoic acid (ALA) supplementation on cardiovascular risk factors in men with chronic spinal cord injury: a clinical trial
TL;DR: It is demonstrated that catheter reuse is intimately linked to UTI frequency and provides novel insight on bladder function and management in elite athletes with SCI.
Abstract: The good, the bad and the ugly of catheterization practices among elite athletes with spinal cord injury: a global perspective
TL;DR: The LUT triggers of episodes of AD are often associated with iatrogenic urological procedures, and were more prevalent in cervical SCI than in thoracic SCI.
Abstract: This is a systematic review. The objective of this study was to review the literature on iatrogenic urological triggers of autonomic dysreflexia (AD). This study was conducted in an international setting. A systematic review was conducted from PubMed search using AD/ autonomic hyperreflexia and spinal cord injury (SCI). Studies selected for review involved iatrogenic urological triggers of AD in individuals with SCI, including original articles, previous practice guidelines, case reports and literature reviews. Studies that did not report AD or blood pressure (BP) assessments during urological procedures were excluded. Forty studies were included for analysis and categorized into four groups: (1) urodynamics and cystometry; (2) cystoscopy and transurethral litholapaxy; (3) extracorporeal shock-wave lithotripsy (ESWL); and (4) other procedures. During urodynamics, the incidence of AD ranged from 36.7% to 77.8%. The symptomatic rate ranged from 50% to 65%, with AD symptoms seen predominantly in cervical SCI patients. The studies imply no consensus regarding the relationship between AD, neurogenic detrusor overactivity and detrusor sphincter dyssynergia. Without anesthesia, the majority of individuals develop AD during cystoscopy, transurethral litholapaxy and ESWL. The effectiveness of different anesthesia methods relies on blocking the nociceptive signals from the lower urinary tract (LUT) below the level of the neurological lesion. Other iatrogenic urological triggers were commonly associated with bladder filling. The LUT triggers of episodes of AD are often associated with iatrogenic urological procedures. AD was more prevalent in cervical SCI than in thoracic SCI. To detect this potential life-threatening complication following cervical and high thoracic SCI, routine BP monitoring during urological procedures is highly recommended.
TL;DR: A sustained significant improvement in defecation symptoms and quality of life for 3 years in spina bifida children who underwent continuous TAI is observed.
Abstract: Experimental, prospective study. We evaluated the long-term clinical efficacy of transanal irrigation (TAI) and its effect on the quality of life of spina bifida children and their caregivers. Republic of Korea. Forty-four spina bifida pediatric patients with constipation, fecal incontinence or both, underwent a TAI program at our spina bifida clinic between December 2010 and October 2013. The children and their caregivers were evaluated using a self-administered questionnaire before TAI and at 3 months and 3 years after initiation of the program. Successful treatment outcome was achieved in 38 (86.4%) children after a mean follow-up duration of 33 months (range, 30–36). The mean number of fecal incontinence episodes per week, the number of diaper changes and the total time for bowel care per day before the program decreased at the latest follow-up examination from 7.3 to 0.4 (P<0.001), 1.6 to 0.2 (P<0.001) and 29.2 to 19.4 min (P=0.038), respectively. These results remained constant from short-term follow-up at 3 months to 3 years. Caregivers and children could go out more often (P=0.002), and the emotional impact of bowel care on caregivers decreased (P<0.001). The reported mean overall satisfaction with TAI was 8/10. The common adverse effect during TAI was abdominal discomfort (60.5%). We observed a sustained significant improvement in defecation symptoms and quality of life for 3 years in spina bifida children who underwent continuous TAI.
TL;DR: JNK signal transduction pathway is involved in the pain signaling transduction of astrocytes in chronic constriction injury rats and is associated with nerve cells or glial cell associations.
Abstract: To investigate the signaling pathways after astrocytes were activated in neuropathic pain. Thirty-six Sprague Dawley (s.d.) rats were randomly divided into two groups (each group with 18 s.d. rats) including chronic constriction injury (CCI) of the sciatic nerve model group and sham operation group. Operation was perform ed on the right leg in all rats. The lumbar spin al cord (L4 and L5) was taken to make paraffin slices on the 1st day before operation and the 1st, 3rd, 7th, 14th and 28th day after operation in each group. Paraffin slices were labeled with p38 mitogen-activated protein kinase (p38MAPK) and c-Jun N-terminal kinase (JNK) by immunofluorescence staining, and then were co-labeled with hexaribonucleotide binding protein-3 (NeuN), glial fibrillary acidic protein (GFAP) and anti-integrin αM (CD11b) antibody (OX-42) to explore the associations of p38MAPK and JNK with nerve cells or glial cell. Compared with sham group, the pain threshold was significantly decreased, and astrocyte-activated markers, GFAP and vimentin were significantly increased in CCI group. The mean fluorescence intensities of p38MAPK and JNK were increased in the right spinal dorsal horn of CCI group. The coexpression of JNK and GFAP was found in astrocytes of the spinal dorsal horn in CCI group. JNK signal transduction pathway is involved in the pain signaling transduction of astrocytes.
TL;DR: Beyond mandated physical accessibility, accommodation of individuals who are reliant on wheelchairs because of SCI or other paralytic conditions was found to be lacking and it remains important for health-care professionals and other advocacy groups to stress the need for inclusion and accommodation of Individuals with disabilities to community fitness facilities allowing wellness needs to be met.
Abstract: Adhering to the recommended healthy physical activity guidelines can be difficult for individuals with spinal cord injury (SCI), stroke or other paralytic conditions. Ordinary community structures such as curbs, stairs and narrow passageways can present as major obstacles for individuals who are reliant on wheelchairs. The Americans with Disabilities Act (ADA) of 1990 mandates that public facilities, including community fitness centers, should be accessible to everyone. Analysis of compliance of the ADA and accommodation of wheelchair-reliant individuals. To determine the level of compliance with ADA and the degree of accommodation of wheelchair-reliant individuals. Community fitness centers in the Hattiesburg, Mississippi metropolitan area. Ten fitness centers consented to unfettered access for evaluation of ADA compliance and accommodation of wheelchair-reliant individuals using an 82-item checklist. All surveyed facilities were found to be partially compliant, with none of the facilities being 100% compliant. The areas of least compliance were access to and free movement around exercise equipment and full access to restrooms. Beyond ADA accessibility, only 20% of the participating facilities provided suitable adaptive equipment, and no facilities employed staff trained for the special needs of those with paralytic conditions. Beyond mandated physical accessibility, accommodation of individuals who are reliant on wheelchairs because of SCI or other paralytic conditions was found to be lacking. It remains important for health-care professionals and other advocacy groups to stress the need for inclusion and accommodation of individuals with disabilities to community fitness facilities allowing wellness needs to be met.
TL;DR: Investigating changes in HRV patterns and alterations in patients with acute traumatic SCI found that the autonomic nervous system function differs between C1-C8, T1-T5 and T6-T12 patients suggest that the sympathovagal balance in both the C1/C8 and T1/T5 SCI patients has yet to be reached.
Abstract: Assessment of autonomic function after acute spinal cord injury using heart rate variability analyses
TL;DR: Most difficult classification tasks were the correct determination of motor levels and the differentiation between AIS B and AIS C/D.
Abstract: International standards for neurological classification of spinal cord injury: classification skills of clinicians versus computational algorithms
TL;DR: The findings indicated that depression and anxiety are two psychologically important side effects after SCI and that religion and spiritual well-being have a moderating role on occurrence of anxiety and anxiety.
Abstract: OBJECTIVES: We evaluate the level of anxiety and depression among patients with spinal cord injury (SCI) in relation with their religious coping and spiritual health. SETTING: Brain and Spinal Cord Injury Repair Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. METHODS: A sample of patients with SCI participated in this cross-sectional study. They completed a sociodemographic questionnaire, the Hospital Anxiety and Depression Scale, the Brief Religious Coping Questionnaire and the Spiritual Well-being Scale. Then, the association between anxiety, depression and independent variables was examined. RESULTS: In all, 213 patients with SCI were studied. Of these, 64 (30%) have had anxiety and 32 (15%) have had depression. Multiple logistic regression analyses revealed that gender (odds ratio (OR) for female=3.34, 95% confidence interval (CI)=1.31-8.51, P=0.011), employment (OR for unemployed=5.71, 95% CI=1.17-27.78, P=0.031), negative religious coping (OR=1.15, 95% CI=1.04-1.28, P=0.006) and existential spiritual well-being (OR=0.93, 95% CI=0.89-0.97, P=0.003) were significant contributing factors to anxiety (Table 3), whereas negative religious coping (OR=1.21, 95% CI=1.06-1.37, P=0.004) and existential spiritual well-being (OR=0.90, 95% CI=0.84-0.96, P=0.001) were significant contributing factors to depression. CONCLUSION: The findings indicated that depression and anxiety are two psychologically important side effects after SCI. The findings also indicated that religion and spiritual well-being have a moderating role on occurrence of depression and anxiety.Spinal Cord advance online publication, 30 June 2015; doi:10.1038/sc.2015.102. Language: en