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YARROW JOSHUAF, WNEK RUSSELLD, CONOVER CHRISTINEF, REYNOLDS MICHAELC, BUCKLEY KINLEYH, KURA JAYACHANDRAR, SUTOR TOMMYW, OTZEL DANAM, MATTINGLY ALEXJ, BORST STEPHENE, CROFT SUMMERM, AGUIRRE JIGNACIO, BECK DARRENT, MCCULLOUGH DANIELLEJ. Passive Cycle Training Promotes Bone Recovery after Spinal Cord Injury without Altering Resting-State Bone Perfusion. Med Sci Sports Exerc 2023; 55:813-823. [PMID: 36728986 PMCID: PMC10090357 DOI: 10.1249/mss.0000000000003101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Spinal cord injury (SCI) produces diminished bone perfusion and bone loss in the paralyzed limbs. Activity-based physical therapy (ABPT) modalities that mobilize and/or reload the paralyzed limbs (e.g., bodyweight-supported treadmill training (BWSTT) and passive-isokinetic bicycle training) transiently promote lower-extremity blood flow (BF). However, it remains unknown whether ABPT alter resting-state bone BF or improve skeletal integrity after SCI. METHODS Four-month-old male Sprague-Dawley rats received T 9 laminectomy alone (SHAM; n = 13) or T 9 laminectomy with severe contusion SCI ( n = 48). On postsurgery day 7, SCI rats were stratified to undergo 3 wk of no ABPT, quadrupedal (q)BWSTT, or passive-isokinetic hindlimb bicycle training. Both ABPT regimens involved two 20-min bouts per day, performed 5 d·wk -1 . We assessed locomotor recovery, bone turnover with serum assays and histomorphometry, distal femur bone microstructure using in vivo microcomputed tomography, and femur and tibia resting-state bone BF after in vivo microsphere infusion. RESULTS All SCI animals displayed immediate hindlimb paralysis. SCI without ABPT exhibited uncoupled bone turnover and progressive cancellous and cortical bone loss. qBWSTT did not prevent these deficits. In comparison, hindlimb bicycle training suppressed surface-level bone resorption indices without suppressing bone formation indices and produced robust cancellous and cortical bone recovery at the distal femur. No bone BF deficits existed 4 wk after SCI, and neither qBWSTT nor bicycle altered resting-state bone perfusion or locomotor recovery. However, proximal tibia BF correlated with several histomorphometry-derived bone formation and resorption indices at this skeletal site across SCI groups. CONCLUSIONS These data indicate that passive-isokinetic bicycle training reversed cancellous and cortical bone loss after severe SCI through antiresorptive and/or bone anabolic actions, independent of locomotor recovery or changes in resting-state bone perfusion.
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Affiliation(s)
- JOSHUA F. YARROW
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL
- Brain Rehabilitation Research Center, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL
- Division of Endocrinology, Diabetes, and Metabolism, University of Florida College of Medicine, Gainesville, FL
| | - RUSSELL D. WNEK
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL
| | - CHRISTINE F. CONOVER
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL
| | - MICHAEL C. REYNOLDS
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL
| | - KINLEY H. BUCKLEY
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL
| | - JAYACHANDRA R. KURA
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL
| | - TOMMY W. SUTOR
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL
| | - DANA M. OTZEL
- Brain Rehabilitation Research Center, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL
| | - ALEX J. MATTINGLY
- Geriatrics Research, Education, and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL
| | - STEPHEN E. BORST
- Geriatrics Research, Education, and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL
| | - SUMMER M. CROFT
- Department of Physiological Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL
| | - J. IGNACIO AGUIRRE
- Department of Physiological Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL
| | - DARREN T. BECK
- Department of Cell Biology and Physiology, Edward Via College of Osteopathic Medicine – Auburn Campus, Auburn, AL
| | - DANIELLE J. MCCULLOUGH
- Department of Medical Education, Edward Via College of Osteopathic Medicine – Auburn Campus, Auburn, AL
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Nakata T, Shibasaki M, Nishimura Y, Kinoshita T, Hashizaki T, Kamijo YI, Kouda K, Umemoto Y, Tajima F. Quantification of catecholamine neurotransmitters released from cutaneous vasoconstrictor nerve endings in men with cervical spinal cord injury. Am J Physiol Regul Integr Comp Physiol 2023; 324:R345-R352. [PMID: 36693170 DOI: 10.1152/ajpregu.00063.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Control of cutaneous circulation is critically important to maintain thermoregulation, especially in individuals with cervical spinal cord injury (CSCI) who have no or less central thermoregulatory drive. However, the peripheral vasoconstrictor mechanism and capability have not been fully investigated after CSCI. Post- and presynaptic sensitivities of the cutaneous vasoconstrictor system were investigated in 8 CSCI and 7 sedentary able-bodied (AB) men using an intradermal microdialysis technique. Eight doses of norepinephrine (NE, 10-8 to 10-1 M) and five doses of tyramine (TY, 10-8, 10-5 to 10-2 M) were administered into the anterior right and left thigh, respectively. Endogenous catecholamines, noradrenaline, and dopamine, collected at the TY site, were determined by high-performance liquid chromatography with electrochemical detection. Regardless of vasoconstrictor agents, cutaneous vascular conductance decreased dose-dependently and responsiveness was similar between the groups (NE: Group P = 0.255, Dose P = 0.014; TY: Group P = 0.468, Dose P < 0.001), whereas the highest dose of each drug induced cutaneous vasodilation. Administration of TY promoted the release of noradrenaline and dopamine in both groups. Notably, the amount of noradrenaline released was similar between the groups (P = 0.819), although the concentration of dopamine was significantly greater in individuals with CSCI than in AB individuals (P = 0.004). These results suggest that both vasoconstrictor responsiveness and neural functions are maintained after CSCI, and dopamine in the skin is likely to induce cutaneous vasodilation.
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Affiliation(s)
- Tomonori Nakata
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | | | - Yukihide Nishimura
- Department of Rehabilitation Medicine, Iwate Medical University, Wakayama, Japan
| | - Tokio Kinoshita
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan.,Division of Rehabilitation, Wakayama Medical University Hospital, Wakayama, Japan
| | - Takamasa Hashizaki
- Division of Rehabilitation, Wakayama Medical University Hospital, Wakayama, Japan
| | - Yoshi-Ichiro Kamijo
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan.,Department of Rehabilitation Medicine, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Ken Kouda
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasunori Umemoto
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
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Predictors of lower extremity fracture-related amputation in persons with traumatic spinal cord injury: a case-control study. Spinal Cord 2023; 61:260-268. [PMID: 36797477 DOI: 10.1038/s41393-023-00879-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 01/06/2023] [Accepted: 02/01/2023] [Indexed: 02/18/2023]
Abstract
STUDY DESIGN This is a retrospective case-control study. OBJECTIVES To identify predictors of lower extremity (LE) long bone fracture-related amputation in persons with traumatic spinal cord injury (tSCI). SETTING US Veterans Health Administration facilities (2005-2015). METHODS Fracture-amputation sets in Veterans with tSCI were considered for inclusion if medical coding indicated a LE amputation within 365 days following an incident LE fracture. The authors adjudicated each fracture-amputation set by electronic health record review. Controls with incident LE fracture and no subsequent amputation were matched 1:1 with fracture-amputation sets on site and date of fracture (±30 days). Multivariable conditional logistic regression determined odds ratios (OR) and 95% confidence intervals (CI) for potential predictors (motor-complete injury; diabetes mellitus (DM); peripheral vascular disease (PVD); smoking; primary (within 30 days) nonsurgical fracture management; pressure injury and/or infection), controlling for age and race. RESULTS Forty fracture-amputation sets from 37 Veterans with LE amputations and 40 unique controls were identified. DM (OR = 26; 95% CI, 1.7-382), PVD (OR = 30; 95% CI, 2.5-371), and primary nonsurgical management (OR = 40; 95% CI, 1.5-1,116) were independent predictors of LE fracture-related amputation. CONCLUSIONS Early and aggressive strategies to prevent DM and PVD in tSCI are needed, as these comorbidities are associated with increased odds of LE fracture-related amputation. Nonsurgical fracture management increased the odds of LE amputation by at least 50%. Further large, prospective studies of fracture management in tSCI are needed to confirm our findings. Physicians and patients should consider the potential increased risk of amputation associated with non-operative management of LE fractures in shared decision making.
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Mohamad Saadon NS, Hamzaid NA, Hasnan N, Dzulkifli MA, Teoh M, Davis GM. Mechanomyography And Tissue Oxygen Saturation During
Electrically‐Evoked
Wrist Extensor Fatigue In People With Tetraplegia. Artif Organs 2022; 46:1998-2008. [DOI: 10.1111/aor.14329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Nurul Salwani Mohamad Saadon
- Department of Biomedical Engineering, Faculty of Engineering University of Malaya 50603 Kuala Lumpur Malaysia
- Clinical Investigation Centre (CIC), 5th Floor East Tower University Malaya Medical Centre 59100 Kuala Lumpur Malaysia
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering University of Malaya 50603 Kuala Lumpur Malaysia
| | - Nazirah Hasnan
- Department of Rehabilitation Medicine, Faculty of Medicine University of Malaya 50603 Kuala Lumpur Malaysia
| | - Muhammad Afiq Dzulkifli
- Department of Biomedical Engineering, Faculty of Engineering University of Malaya 50603 Kuala Lumpur Malaysia
| | - Mira Teoh
- Department of Biomedical Engineering, Faculty of Engineering University of Malaya 50603 Kuala Lumpur Malaysia
| | - Glen M. Davis
- Clinical Exercise and Rehabilitation Unit, Discipline of Exercise and Sports Sciences, Sydney School of Health Sciences, Faculty of Medicine and Health University of Sydney NSW Australia
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Yu Z, Cheng X, Chen J, Huang Z, He S, Hu H, Lin S, Zou Z, Huang F, Chen B, Wan Y, Peng X, Zou X. Spinal Cord Parenchyma Vascular Redistribution Underlies Hemodynamic and Neurophysiological Changes at Dynamic Neck Positions in Cervical Spondylotic Myelopathy. Front Neuroanat 2021; 15:729482. [PMID: 34887731 PMCID: PMC8650056 DOI: 10.3389/fnana.2021.729482] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Cervical spondylotic myelopathy (CSM) is a degenerative condition of the spine that caused by static and dynamic compression of the spinal cord. However, the mechanisms of motor and somatosensory conduction, as well as pathophysiological changes at dynamic neck positions remain unclear. This study aims to investigate the interplay between neurophysiological and hemodynamic responses at dynamic neck positions in the CSM condition, and the pathological basis behind. We first demonstrated that CSM patients had more severe dynamic motor evoked potentials (DMEPs) deteriorations upon neck flexion than upon extension, while their dynamic somatosensory evoked potentials (DSSEPs) deteriorated to a similar degree upon extension and flexion. We therefore generated a CSM rat model which developed similar neurophysiological characteristics within a 4-week compression period. At 4 weeks-post-injury, these rats presented decreased spinal cord blood flow (SCBF) and oxygen saturation (SO2) at the compression site, especially upon cervical flexion. The dynamic change of DMEPs was significantly correlated with the change in SCBF from neutral to flexion, suggesting they were more sensitive to ischemia compared to DSSEPs. We further demonstrated significant vascular redistribution in the spinal cord parenchyma, caused by angiogenesis mainly concentrated in the anterior part of the compressed site. In addition, the comparative ratio of vascular densities at the anterior and posterior parts of the cord was significantly correlated with the perfusion decrease at neck flexion. This exploratory study revealed that the motor and somatosensory conductive functions of the cervical cord changed differently at dynamic neck positions in CSM conditions. Compared with somatosensory conduction, the motor conductive function of the cervical cord suffered more severe deteriorations upon cervical flexion, which could partly be attributed to its higher susceptibility to spinal cord ischemia. The uneven angiogenesis and vascular distribution in the spinal cord parenchyma might underlie the transient ischemia of the cord at flexion.
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Affiliation(s)
- Zhengran Yu
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xing Cheng
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiacheng Chen
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhong Huang
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hanover, Germany
| | - Shaofu He
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Hu
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sixiong Lin
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiyuan Zou
- Department of Orthopedic, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fangli Huang
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bolin Chen
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yong Wan
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xinsheng Peng
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xuenong Zou
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Yarrow JF, Wnek RD, Conover CF, Reynolds MC, Buckley KH, Kura JR, Sutor TW, Otzel DM, Mattingly AJ, Croft S, Aguirre JI, Borst SE, Beck DT, McCullough DJ. Bone loss after severe spinal cord injury coincides with reduced bone formation and precedes bone blood flow deficits. J Appl Physiol (1985) 2021; 131:1288-1299. [PMID: 34473574 DOI: 10.1152/japplphysiol.00444.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Diminished bone perfusion develops in response to disuse and has been proposed as a mechanism underlying bone loss. Bone blood flow (BF) has not been investigated within the unique context of severe contusion spinal cord injury (SCI), a condition that produces neurogenic bone loss that is precipitated by disuse and other physiological consequences of central nervous system injury. Herein, 4-mo-old male Sprague-Dawley rats received T9 laminectomy (SHAM) or laminectomy with severe contusion SCI (n = 20/group). Time course assessments of hindlimb bone microstructure and bone perfusion were performed in vivo at 1- and 2-wk postsurgery via microcomputed tomography (microCT) and intracardiac microsphere infusion, respectively, and bone turnover indices were determined via histomorphometry. Both groups exhibited cancellous bone loss beginning in the initial postsurgical week, with cancellous and cortical bone deficits progressing only in SCI thereafter. Trabecular bone deterioration coincided with uncoupled bone turnover after SCI, as indicated by signs of ongoing osteoclast-mediated bone resorption and a near-complete absence of osteoblasts and cancellous bone formation. Bone BF was not different between groups at 1 wk, when both groups displayed bone loss. In comparison, femur and tibia perfusion was 30%-40% lower in SCI versus SHAM at 2 wk, with the most pronounced regional BF deficits occurring at the distal femur. Significant associations existed between distal femur BF and cancellous and cortical bone loss indices. Our data provide the first direct evidence indicating that bone BF deficits develop in response to SCI and temporally coincide with suppressed bone formation and with cancellous and cortical bone deterioration.NEW & NOTEWORTHY We provide the first direct evidence indicating femur and tibia blood flow (BF) deficits exist in conscious (awake) rats after severe contusion spinal cord injury (SCI), with the distal femur displaying the largest BF deficits. Reduced bone perfusion temporally coincided with unopposed bone resorption, as indicated by ongoing osteoclast-mediated bone resorption and a near absence of surface-level bone formation indices, which resulted in severe cancellous and cortical microstructural deterioration after SCI.
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Affiliation(s)
- Joshua F Yarrow
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida.,Brain Rehabilitation Research Center, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida.,Division of Endocrinology, Diabetes, and Metabolism, University of Florida College of Medicine, Gainesville, Florida
| | - Russell D Wnek
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Christine F Conover
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Michael C Reynolds
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Kinley H Buckley
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Jayachandra R Kura
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Tommy W Sutor
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Dana M Otzel
- Brain Rehabilitation Research Center, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Alex J Mattingly
- Geriatrics Research, Education, and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Summer Croft
- Department of Physiological Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida
| | - J Ignacio Aguirre
- Department of Physiological Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida
| | - Stephen E Borst
- Research Service, Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Darren T Beck
- Department of Cell Biology and Physiology, Edward Via College of Osteopathic Medicine-Auburn Campus, Auburn, Alabama
| | - Danielle J McCullough
- Department of Cell Biology and Physiology, Edward Via College of Osteopathic Medicine-Auburn Campus, Auburn, Alabama
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Increased risk of sensorineural hearing loss in patients with spinal cord injury: a nationwide longitudinal follow-up study. Spinal Cord 2021; 59:1200-1205. [PMID: 34417551 DOI: 10.1038/s41393-021-00697-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cohort study with 10 years follow-up. OBJECTIVE To compare the risks of sensorineural hearing loss in patients with and without spinal cord injury, based on a nationally representative sample. SETTING Taiwan's Longitudinal Health Insurance Database 2005. METHOD A total of 2006 participants who had been aged between 20 and 69 and who had spinal cord injury as of 2002-06 were enrolled in the spinal cord injury group. The non-spinal cord injury group consisted of 8024 sex- and age-matched, randomly sampled participants without spinal cord injury. Then, their sensorineural hearing loss -cumulative incidence curves were generated using the Kaplan-Meier method. Stratified Cox proportional-hazard regression was employed to estimate the effect of having spinal cord injury on patients' subsequent risk of sensorineural hearing loss. RESULTS During the follow-up, 30 patients in the spinal cord injury group and 87 in the non-spinal cord injury group developed sensorineural hearing loss. As such, the cumulative incidence of sensorineural hearing loss was significantly higher in the spinal cord injury group than the non-spinal cord injury group (2.16 vs. 1.21 per 1000 person-years, p = 0.008). The adjusted hazard ratio of sensorineural hearing loss for the spinal cord injury group was 1.75 times that of the non-spinal cord injury group (95% CI, 1.14-2.68, p = 0.01). The patients with non-cervical SCI appeared to have a higher magnitude of SNHL risk than their cervical SCI counterparts. CONCLUSION Our study showed that patients with spinal cord injury have an increased risk of developing sensorineural hearing loss.
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Lu QA, Wang YS, Xie JM, Li T, Shi ZY, Du ZS, Zhang Y, Zhao Z, Bi N. Effect of Spinal Shortening for Protection of Spinal Cord Function in Canines with Spinal Cord Angulation. Med Sci Monit 2019; 25:9192-9199. [PMID: 31791038 PMCID: PMC6909917 DOI: 10.12659/msm.919313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Posterior vertebral column resection (PVCR) has been widely used as a treatment for severe spinal deformity. By using the canine model of vertebral column resection, this study explored the effect of spinal shortening on blood flow and function of the spinal cord during spinal cord angulation. Material/Methods The canine model of L1 vertebral column resection was constructed with the PVCR technique. The canines were divided into 5 groups according to the degree of shortening: the 0/4 group, the 1/4 group, the 2/4 group, the 3/4 group, and the control group. Spinal cord blood flow, neuroelectrophysiology, HE staining, nitric oxide, and endothelin-1 were measured during the procedure of vertebral column resection and spinal cord angulation. Results The results showed that, in the 1/4 group and the 2/4 group, the blood flow of the spinal cord decreased by 16.5% and 10.6%, respectively, with no obvious damage in the spinal cord; in the 0/4 group and the 3/4 group, the blood flow decreased by 23.5% and 23.1%, respectively, with significant damage in the spinal cord. Conclusions When the spinal cord is shortened by 1/4 to 2/4, the tolerance of the spinal cord can increase and spinal cord injury resulting from angulation can be avoided. However, when the shortening reaches 3/4, it is harmful to the spinal cord. Proper shortening of the spinal cord by 1/4 to 2/4 may increase the tolerance of the spinal cord to the damage caused by angulation during PVCR.
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Affiliation(s)
- Qiu-An Lu
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Ying-Song Wang
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Jing-Ming Xie
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Tao Li
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Zhi-Yue Shi
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Zhi-Shan Du
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Ying Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Zhi Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Ni Bi
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China (mainland)
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Influence of cervical spinal cord injury on thermoregulatory and cardiovascular responses in the human body: Literature review. J Clin Neurosci 2019; 69:7-14. [DOI: 10.1016/j.jocn.2019.08.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/04/2019] [Indexed: 11/20/2022]
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10
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Mneimneh F, Ghaddar N, Ghali K, Moussalem C, Omeis I. Would personal cooling vest be effective for use during exercise by people with thoracic spinal cord injury? J Therm Biol 2019; 82:123-141. [PMID: 31128640 DOI: 10.1016/j.jtherbio.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/08/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Abstract
People with thoracic spinal cord injury (SCI), named people with paraplegia (PA), are vulnerable to thermal heat stress during exercise due to disruption in their thermal physiology. Using personal cooling vests with phase change material (PCM) or ice presents a possible solution for PA to suppress the increase in core temperature and body heat storage. With the limited published experimental studies about effective cooling vest for PA, this work aims to develop an altered PA bioheat model combined with cooling vest model to study cooling vest performance during exercise. The integrated PA bioheat and vest models predict core and skin temperatures, latent and sensible heat losses and change in body heat storage for PA with and without a cooling vest. The models were validated with published experimental data on PA without the cooling vest and on PA with two cooling vests; one using PCM at melting temperature of 15 °C and the other using ice packets during exercise. It was observed that sensible heat losses at the four torso segments (abdomen, lower back, chest and upper back) increased with the vest case compared to the no-vest case; while, latent heat losses decreased compared to the no-vest case. However, insignificant change was seen in core temperatures and body heat storage as was also reported experimentally. The performance of each of the cooling vest during exercise on PA was dependent on skin coverage area and melting temperatures.
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Affiliation(s)
- Farah Mneimneh
- Mechanical Engineering Department, American University of Beirut, P.O. Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Nesreen Ghaddar
- Mechanical Engineering Department, American University of Beirut, P.O. Box 11-0236, Beirut, 1107-2020, Lebanon.
| | - Kamel Ghali
- Mechanical Engineering Department, American University of Beirut, P.O. Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Charbel Moussalem
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad El Solh Beirut, 1107 2020, Beirut, Lebanon
| | - Ibrahim Omeis
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad El Solh Beirut, 1107 2020, Beirut, Lebanon
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Jing Y, Bai F, Chen H, Dong H. Using Laser Doppler Imaging and Monitoring to Analyze Spinal Cord Microcirculation in Rat. J Vis Exp 2018. [PMID: 29912181 DOI: 10.3791/56243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Laser Doppler flowmetry (LDF) is a noninvasive method for blood flow (BF) measurement, which makes it preferable for measuring microcirculatory alterations of the spinal cord. In this article, our goal was to use both Laser Doppler imaging and monitoring to analyze the change of BF after spinal cord injury. Both the laser Doppler image scanner and the probe/monitor were being employed to obtain each readout. The data of LDPI provided a local distribution of BF, which gave an overview of perfusion around the injury site and made it accessible for comparative analysis of BF among different locations. By intensely measuring the probing area over a period of time, a combined probe was used to simultaneously measure the BF and oxygen saturation of the spinal cord, showing overall spinal cord perfusion and oxygen supply. LDF itself has a few limitations, such as relative flux, sensitivity to movement, and biological zero signal. However, the technology has been applied in clinical and experimental study due to its simple setup and rapid measurement of BF.
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Affiliation(s)
- Yingli Jing
- China Rehabilitation Research Center; Institute of Rehabilitation Science of China; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Neural Injury and Rehabilitation
| | - Fan Bai
- China Rehabilitation Research Center; Institute of Rehabilitation Science of China; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Neural Injury and Rehabilitation
| | - Hui Chen
- China Rehabilitation Research Center; Institute of Rehabilitation Science of China; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Neural Injury and Rehabilitation
| | - Hao Dong
- China Rehabilitation Research Center; Institute of Rehabilitation Science of China; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Neural Injury and Rehabilitation;
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Gollie JM. Fatigability during volitional walking in incomplete spinal cord injury: cardiorespiratory and motor performance considerations. Neural Regen Res 2018; 13:786-790. [PMID: 29862998 PMCID: PMC5998625 DOI: 10.4103/1673-5374.232461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2018] [Indexed: 02/06/2023] Open
Abstract
Fatigability describes the decline in force production (i.e., performance fatigability) and/or changes in sensations regulating performance (i.e., perceived fatigability) during whole-body activity and poses a major challenge to those living with spinal cord injuries (SCI). After SCI, the inability to overcome disruptions to metabolic homeostasis due to cardiorespiratory limitations and physical deconditioning may contribute to increased fatigability severity. The increased susceptibility to fatigability may have implications for motor control strategies and motor learning. Locomotor training approaches designed to reduce fatigability and enhance aerobic capacity in combination with motor learning may be advantageous for promoting functional recovery after SCI. Future research is required to advance the understanding of the relationship between fatigability, cardiorespiratory function and motor performance following SCI.
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Affiliation(s)
- Jared M. Gollie
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center-Human Performance Research Unit, Veteran Affairs Medical Center Washington, DC, USA
- Department of Health, Human Function, and Rehabilitation Sciences, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
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13
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Hickey K, Stabenfeldt SE. Using biomaterials to modulate chemotactic signaling for central nervous system repair. Biomed Mater 2018; 13:044106. [PMID: 29411713 PMCID: PMC5991092 DOI: 10.1088/1748-605x/aaad82] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Chemotaxis enables cellular communication and movement within the body. This review focuses on exploiting chemotaxis as a tool for repair of the central nervous system (CNS) damaged from injury and/or degenerative diseases. Chemokines and factors alone may initiate repair following CNS injury/disease, but exogenous administration may enhance repair and promote regeneration. This review will discuss critical chemotactic molecules and factors that may promote neural regeneration. Additionally, this review highlights how biomaterials can impact the presentation and delivery of chemokines and growth factors to alter the regenerative response.
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Affiliation(s)
- Kassondra Hickey
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States of America
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14
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Draghici AE, Potart D, Hollmann JL, Pera V, Fang Q, DiMarzio CA, Taylor JA, Niedre MJ, Shefelbine SJ. Near infrared spectroscopy for measuring changes in bone hemoglobin content after exercise in individuals with spinal cord injury. J Orthop Res 2018; 36:183-191. [PMID: 28561268 PMCID: PMC5711624 DOI: 10.1002/jor.23622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 05/19/2017] [Indexed: 02/04/2023]
Abstract
Bone blood perfusion has an essential role in maintaining a healthy bone. However, current methods for measuring bone blood perfusion are expensive and highly invasive. This study presents a custom built near-infrared spectroscopy (NIRS) instrument to measure changes in bone blood perfusion. We demonstrated the efficacy of this device by monitoring oxygenated and deoxygenated hemoglobin changes in the human tibia during and after exercise in able-bodied and in individuals with spinal cord injury (SCI), a population with known impaired peripheral blood perfusion. Nine able-bodied individuals and six volunteers with SCI performed a 10 min rowing exercise (functional electrical stimulation rowing for those with SCI). With exercise, during rowing, able-bodied showed an increase in deoxygenated hemoglobin in the tibia. Post rowing, able-bodied showed an increase in total blood content, characterized by an increase in total hemoglobin content due primarily to an increase in deoxygenated hemoglobin. During rowing and post-rowing, those with SCI showed no change in total blood content in the tibia. The current study demonstrates that NIRS can non-invasively detect changes in hemoglobin concentration in the tibia. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:183-191, 2018.
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Affiliation(s)
- Adina E. Draghici
- Department of Bioengineering, Northeastern University, Boston, MA, USA
| | - Diane Potart
- Université de Technologie Compiègne, Compiègne, France
| | | | - Vivian Pera
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Qianqian Fang
- Department of Bioengineering, Northeastern University, Boston, MA, USA,Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, USA
| | - Charles A. DiMarzio
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, USA
| | - J. Andrew Taylor
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, MA, USA,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Mark J. Niedre
- Department of Bioengineering, Northeastern University, Boston, MA, USA,Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, USA
| | - Sandra J. Shefelbine
- Department of Bioengineering, Northeastern University, Boston, MA, USA,Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
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15
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Sundby ØH, Høiseth LØ, Irgens I, Mathiesen I, Lundgaard E, Haugland H, Weedon-Fekjær H, Sundhagen JO, Sanbæk G, Hisdal J. Intermittent negative pressure applied to the lower limb increases foot macrocirculatory and microcirculatory blood flow pulsatility in people with spinal cord injury. Spinal Cord 2017; 56:382-391. [DOI: 10.1038/s41393-017-0049-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/02/2017] [Accepted: 12/04/2017] [Indexed: 12/15/2022]
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16
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Jing Y, Bai F, Chen H, Dong H. Meliorating microcirculatory with melatonin in rat model of spinal cord injury using laser Doppler flowmetry. Neuroreport 2016; 27:1248-1255. [PMID: 27648716 DOI: 10.1097/wnr.0000000000000686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Garbeloti EJR, Paiva RCA, Restini CBA, Durand MT, Miranda CES, Teixeira VE. Biochemical biomarkers are not dependent on physical exercise in patients with spinal cord injury. BBA CLINICAL 2016; 6:5-11. [PMID: 27331022 PMCID: PMC4900297 DOI: 10.1016/j.bbacli.2016.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 11/05/2022]
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18
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Schewitz J, Roos R, van Aswegen H, Manda S. The effect of two passive head-down tilt positions on diaphragm excursion in healthy adults: A preliminary study. Physiother Theory Pract 2016; 32:223-31. [PMID: 27043164 DOI: 10.3109/09593985.2015.1137664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE A head-down tilt position could influence diaphragm excursion due to abdominal content displacement. The purpose of the study was to determine if excursion could be influenced by a head-down tilt position and if this change in excursion alters the diaphragm function. DESIGN Prospective quasi-experimental study. PARTICIPANTS Seventy healthy adult students. INTERVENTION Four head-down tilt positions: 1) 15° (30 seconds); 2) 15° (120 seconds); 3) 30° (30 seconds); and 4) 30° (120 seconds). OUTCOME MEASURES Change in diaphragm excursion was assessed using M-Mode ultrasound and diaphragm function was recorded in terms of the peak expiratory flow rate (PEFR) and thoracic expansion. Data were analyzed using descriptive statistics, Analysis of Variance (ANOVA), Kruskal Wallis and student's t-test. RESULTS The cohort consisted of 56 women (80%) and 14 men (20%) with a mean age of 20.7 (±1.7) years and a mean body mass index (BMI) of 23.0 (±3.7) kg/m(2). The greatest mean change in the hemi-diaphragm, for both genders measured from rest, was 38.8 (±11.5) mm on the left and 39.4 (±11.9) mm on the right. The greatest stretch occurred after a 30° head-down tilt for 30 seconds for both the right and left hemi-diaphragms in males and right hemi-diaphragm in females. The left hemi-diaphragm in females achieved its maximum stretch after 30° head-down tilt for 120 seconds. No significant changes in thoracic expansion or PEFR were observed but baseline values were less than predicted. CONCLUSION Optimal change in hemi-diaphragm excursion was obtained utilizing 30° head-down tilt positions in healthy subjects.
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Affiliation(s)
- Jacqui Schewitz
- a Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Ronel Roos
- a Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Heleen van Aswegen
- a Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Samuel Manda
- b Biostatistics Unit, South African Medical Research Council , Pretoria , South Africa
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Vascular health toolbox for spinal cord injury: Recommendations for clinical practice. Atherosclerosis 2015; 243:373-82. [DOI: 10.1016/j.atherosclerosis.2015.10.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 11/20/2022]
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20
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Su TW, Chou TY, Jou HJ, Yang PY, Lin CL, Sung FC, Hsu CY, Kao CH. Peripheral Arterial Disease and Spinal Cord Injury: A Retrospective Nationwide Cohort Study. Medicine (Baltimore) 2015; 94:e1655. [PMID: 26469900 PMCID: PMC4616813 DOI: 10.1097/md.0000000000001655] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to elucidate the relationship between spinal cord injury (SCI) and the risk of peripheral arterial disease (PAD) in a cohort study with a large representative sample.The National Health Insurance Database was used to select patients who were diagnosed from 2000 to 2010. Patients with a history of PAD were excluded. The SCI group comprised 42,673 patients diagnosed with SCI, and we enrolled 170,389 matched controls (non-SCI group). We used a Cox proportional hazards regression model to analyze the adjusted risk of PAD between the case and control patients.Patients with SCI exhibited a significantly higher risk (hazard ratio [HR] = 1.37; 95% confidence interval [CI] = 1.22-1.53) of PAD than patients without SCI. Patients with diabetes were at the highest risk of developing PAD (adjusted HR = 3.11, 95% CI = 2.80-3.44). Among patients without comorbidity, SCI patients exhibited a significantly higher risk of PAD than non-SCI patients. Furthermore, lumbar, sacral, or coccygeal spine, and multiple spine SCI were significantly associated with an increased risk of PAD (HR = 1.56, 95% CI = 1.33-1.84, HR = 2.11, 95% CI = 1.59-2.79, respectively).SCI is associated with an increased risk of PAD. Future studies should focus on modifying risk factors to reduce PAD risk among patients with SCI.
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Affiliation(s)
- Ta-Wei Su
- From the Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan (TWS); Department of Physical Medicine and Rehabilitation, China Medical University Hospital (TYC, PYY); Department of Orthopedic Surgery, Kuang Tien General Hospital (HJJ); Department of Nursing, Hungkuang University (HJJ); School of Medicine, China Medical University (PYY, CLL); Management Office for Health Data, China Medical University Hospital (CLL, FCS); Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University (FCS, CYH, CHK); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (CHK)
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Martirosyan NL, Kalani MYS, Bichard WD, Baaj AA, Gonzalez LF, Preul MC, Theodore N. Cerebrospinal Fluid Drainage and Induced Hypertension Improve Spinal Cord Perfusion After Acute Spinal Cord Injury in Pigs. Neurosurgery 2015; 76:461-8; discussion 468-9. [DOI: 10.1227/neu.0000000000000638] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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The association between spinal cord injury and acute myocardial infarction in a nationwide population-based cohort study. Spine (Phila Pa 1976) 2015; 40:147-52. [PMID: 25394315 DOI: 10.1097/brs.0000000000000704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A spinal cord injury (SCI) retrospective cohort study was derived from the National Health Insurance Research Database of Taiwan. OBJECTIVE We evaluated risk of acute myocardial infarction (AMI) in patients newly diagnosed with SCI. SUMMARY OF BACKGROUND DATA According to information of the World Health Organization, cardiovascular diseases are the most frequent causes of death in patients with SCI compared with those in the general population. METHODS We obtained claims data from the National Health Insurance Research Database for this cohort study. The SCI group comprised 22,197 patients with a diagnosis of SCI. Case and control patients were based on risk-set sampling in a 1:4 ratio, and we excluded patients with a prior diagnosis of AMI. Comorbidities were categorized as the proportion of prior illnesses in the SCI and non-SCI groups. We used the Cox proportion model to explore adjusted hazard ratio (aHR) for developing AMI between case and control patients. RESULTS Patients with SCI were significantly more likely to exhibit pre-existing illnesses associated with AMI than patients without SCI. Patients with a diagnosis of SCI exhibited significantly higher aHRs for developing AMI than patients without SCI (aHR=1.17; P<0.05). Patients with SCI, compared with patients without SCI, were associated with a subsequent AMI risk (aHR=1.17; P<0.05). Several comorbidities, such as cardiovascular disease (aHR=1.29; P<0.05), chronic obstructive pulmonary disease (aHR=1.51; P<0.05), hypertension (aHR=1.34; P<0.01), and renal disease (aHR=1.76; P<0.05), were associated with an increased AMI risk. Furthermore, T-spine SCI was significantly associated with an AMI risk (aHR=1.38; P<0.05). CONCLUSION Patients with as diagnosis of SCI exhibited an increased risk of AMI compared with patients without SCI. These findings have broad implications for surveillance among patients with SCI, and future studies should evaluate whether risk factor modification can decrease AMI risk among patients with SCI. LEVEL OF EVIDENCE 3.
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23
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Vasiliadis AV, Zafeiridis A, Dipla K, Galanis N, Chatzidimitriou D, Kyparos A, Nikolaidis MG, Vrabas IS. Circulating angiogenic biomolecules at rest and in response to upper-limb exercise in individuals with spinal cord injury. J Spinal Cord Med 2014; 37:226-32. [PMID: 24090471 PMCID: PMC4066432 DOI: 10.1179/2045772313y.0000000141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Individuals with spinal cord injury (SCI) show structural and functional vascular maladaptations and muscle loss in their lower limbs. Angiogenic biomolecules play important roles in physiological and pathological angiogenesis, and are implicated in the maintenance of muscle mass. This study examined the responses of angiogenic molecules during upper-limb aerobic exercise in patients with SCI and in able-bodied (AB) individuals. METHODS Eight SCI patients with thoracic lesions (T6-T12, ASIA A) and eight AB individuals performed an arm-cranking exercise for 30 minutes at 60% of their VO2max. Plasma concentrations of vascular endothelial growth factor (VEGF-A165), VEGF receptor 1 (sVEGFr-1), VEGF receptor 2 (sVEGFr-2), metalloproteinase 2 (MMP-2), and endostatin were measured at rest, after exercise, and at 1.5 and 3.0 hours during recovery. RESULTS The two-way analysis of variance showed non-significant main effects of "group" and significant main effects of "time/exercise" for all angiogenic biomolecules examined (P < 0.01-0.001). The arm-cranking exercise significantly increased plasma concentrations of VEGF, sVEGFr-1, sVEGFr-2, MMP-2, and endostatin in both groups (P < 0.001-0.01). The magnitude of the increase was similar in both patients with SCI and AB individuals, as shown by the non-significant group × time interaction for all angiogenic parameters. CONCLUSIONS Upper-limb exercise (arm-cranking for 30 minutes at 60% of VO2max) is a sufficient stimulus to trigger a coordinated circulating angiogenic response in patients with SCI. The response of angiogenic molecules to upper-limb aerobic exercise in SCI appears relatively similar to that observed in AB individuals.
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Affiliation(s)
- Angelo V. Vasiliadis
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Andreas Zafeiridis
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece,Correspondence to: Andreas Zafeiridis, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Ag. Ioannis, 62110 Serres, Greece.
| | - Konstantina Dipla
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Nikiforos Galanis
- Department of Orthopedics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Greece
| | - Dimitrios Chatzidimitriou
- 2nd Department of Microbiology and National Influenza Center for Northern Greece, Medical School, Aristotle University of Thessaloniki, Greece
| | - Antonios Kyparos
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Michalis G. Nikolaidis
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Ioannis S. Vrabas
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
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Trbovich M, Ortega C, Schroeder J, Fredrickson M. Effect of a cooling vest on core temperature in athletes with and without spinal cord injury. Top Spinal Cord Inj Rehabil 2014; 20:70-80. [PMID: 24574824 DOI: 10.1310/sci2001-70] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND It is well accepted that persons with spinal cord injury (SCI) have impaired ability to regulate core temperature due to impaired vasomotor and sudomotor activity below their level of injury. Impaired heat dissipation puts SCI athletes at great risk of exercise-induced hyperthermia (EIH) (>37.8°C). There is minimal evidence for efficacy of any specific cooling method in SCI athletes in a thermoneutral sport-specific setting. OBJECTIVE To evaluate the extent of EIH in persons with and without SCI and subsequently examine the effect of a cooling vest to attenuate rise in core body temperature (Tc). METHODS SCI (n = 17) and able-bodied (AB; n = 19) athletes participated in a 60-minute intermittent sprinting exercise in a thermoneutral (21.1°C-23.9°C) environment. Participants were separated according to their level of injury: tetraplegia defined as above T1 (TP; n = 6), high paraplegia defined as T5 through T1 (HP; n = 5), low paraplegia defined as T6 and below (LP; n = 6), and AB (n = 19). Tc was recorded at 15-minute intervals using an ingestible thermometer pill. This protocol was completed with a cooling vest (V) and without a cooling vest (NV). RESULTS All SCI and most AB athletes experienced EIH. After 60 minutes, Tc of TP athletes was significantly increased compared to HP (P = .03) and AB athletes (P = .007). There was no significant effect of the vest on Tc over time for any group. CONCLUSIONS TP athletes have the highest risk of exercise-induced hyperthermia. The cooling vest does not significantly attenuate rise in Tc in SCI or AB athletes.
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Affiliation(s)
- Michelle Trbovich
- Department of PM&R, University of Texas Health Science Center at San Antonio , Texas ; Spinal Cord Injury Service, Audie L. Murphy Veteran's Administration Hospital , San Antonio, Texas
| | - Catherine Ortega
- Department of Physical Therapy, University of Texas Health Science Center at San Antonio , Texas
| | - James Schroeder
- Department of PM&R, University of Texas Health Science Center at San Antonio , Texas
| | - Mark Fredrickson
- Department of PM&R, University of Texas Health Science Center at San Antonio , Texas ; Spinal Cord Injury Service, Audie L. Murphy Veteran's Administration Hospital , San Antonio, Texas
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Tzen YT, Brienza DM, Karg PE, Loughlin PJ. Effectiveness of local cooling for enhancing tissue ischemia tolerance in people with spinal cord injury. J Spinal Cord Med 2013; 36:357-64. [PMID: 23820151 PMCID: PMC3758532 DOI: 10.1179/2045772312y.0000000085] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To investigate the effects of localized cooling and cooling rate on pressure-induced ischemia for people with and without neurological deficits. DESIGN A 2 × 3 mixed factorial design with two groups: (1) people with spinal cord injury (SCI) and (2) people without neurological deficits (control), and three test conditions: (1) pressure only, (2) pressure with fast cooling (-4°C/min), and (3) pressure with slow cooling (-0.33°C/min). SETTING University laboratory. PARTICIPANTS Fourteen controls and 14 individuals with SCI. INTERVENTIONS Pressure on the sacrum was 0.4 kPa for 5 minutes, then 8 kPa for 20 minutes, and finally 0.4 kPa for 15 minutes. Fast and slow cooling to 25°C applied during 8 kPa of pressure. OUTCOME MEASURES Reactive hyperemia and its spectral densities in the metabolic, neurogenic, and myogenic frequency ranges. RESULTS In controls, reactive hyperemia was greater in pressure only as compared with both cooling conditions. No change was noted in all spectral densities in both cooling conditions, and only neurogenic spectral density increased without cooling. In subjects with SCI, no difference was noted in reactive hyperemia among conditions. However, metabolic and myogenic spectral densities increased without cooling and all spectral densities increased with slow cooling. No change was noted in all spectral densities with fast cooling. CONCLUSION Local cooling reduced the severity of ischemia in controls. This protective effect may be masked in subjects with SCI due to chronic microvascular changes; however, spectral analysis suggested local cooling may reduce metabolic vasodilation. These findings provide evidence towards the development of support surfaces with temperature control for weight-bearing soft tissues.
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Affiliation(s)
- Yi-Ting Tzen
- University of Pittsburgh, Pittsburgh, PA 15206, USA.
| | - David M. Brienza
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patricia E. Karg
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
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Stoner L, McCully KK. Peak and time-integrated shear rates independently predict flow-mediated dilation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:341-351. [PMID: 22407951 DOI: 10.1002/jcu.21900] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 01/23/2012] [Indexed: 05/31/2023]
Abstract
BACKGROUND To determine whether peak and time-integrated shear rates independently predict flow-mediated dilation (FMD). METHODS Eleven physically active (25 ± 5 years old) male subjects were tested. FMD was defined as the shear rate-diameter relationship. Hierarchical linear modeling was used to estimate brachial artery diameter change with repeated measures of shear rate nested within each subject. Two models were tested: 1) FMD was induced using ischemia-induced hyperemia (2, 4, 6, and 10 minutes); and 2) FMD was induced following transient (ischemia) and steady-state (forearm heating and handgrip exercise) increases in shear rate. For both models we determined whether peak, in addition to time-integrated shear rates, explained a significant portion of variation for diameter change. RESULTS Model 1: Time integrated shear rates explained most of the variation for diameter change. However, peak shear rate explained an additional significant portion of variation. Model 2: The transient condition resulted in significantly (p = 0.012) smaller diameter change per shear rate change than the steady-state condition. However, when specifying peak shear rate as a covariate, the difference between conditions became nonsignificant (p = 0.138). CONCLUSIONS Peak and time-integrated shear rates independently predict FMD. Future studies using the FMD test should consider both parameters.
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Affiliation(s)
- Lee Stoner
- Department of Kinesiology, University of Georgia, Ramsey Center, Athens, GA 30602, USA
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Manella C, Backus D. Gait characteristics, range of motion, and spasticity changes in response to massage in a person with incomplete spinal cord injury: case report. Int J Ther Massage Bodywork 2011; 4:28-39. [PMID: 21589693 PMCID: PMC3088529 DOI: 10.3822/ijtmb.v4i1.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Our study set out to measure the effect of a specific routine of massage on gait characteristics, range of motion, and spasticity in a person with incomplete spinal cord injury. METHODS This descriptive, pre-post case study, conducted at the outpatient program of a rehabilitation facility, used neuromuscular techniques in massage for a 42-year-old man with incomplete chronic C5 spinal cord injury. The massage was applied to the iliopsoas, triceps surae, and hamstring muscle groups for 3 consecutive days. MAIN OUTCOME MEASURES Pre- and post-intervention testing included standard goniometric measurement of joint range of motion in the lower extremities, spasticity evaluation using the modified Ashworth scale, and evaluation of gait characteristics using GAITRite Walkway (CIR Systems, Havertown, PA, USA) pressure mapping for ambulation time, cadence, velocity, stride length, base of support, and single- and double-limb support. RESULTS AFTER THE THERAPEUTIC INTERVENTION, THE FOLLOWING GAIT CHANGES WERE DEMONSTRATED: increase in velocity and cadence of gait, decrease in ambulation time, increase in stride length, and improvements in the percentages of the swing and stance phases of the gait cycle. CONCLUSIONS Specific application of massage therapy influenced gait speed, stride length, and swing and stance phase percentages in one person with incomplete spinal cord injury. Further study is warranted to determine the extent to which massage may affect musculoskeletal and neural impairments that limit gait in people with incomplete spinal cord injury, and the method or routine whose application will yield the most benefit.
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Affiliation(s)
- Christine Manella
- Multiple Sclerosis/Spinal Cord Injury Programs, Shepherd Center, and
| | - Deborah Backus
- Spinal Cord Injury Research, Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
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Bechara SL, Judson A, Popat KC. Template synthesized poly(ɛ-caprolactone) nanowire surfaces for neural tissue engineering. Biomaterials 2010; 31:3492-501. [DOI: 10.1016/j.biomaterials.2010.01.084] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Accepted: 01/12/2010] [Indexed: 10/19/2022]
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Biering-Sørensen B, Kristensen IB, Kjaer M, Biering-Sørensen F. Muscle after spinal cord injury. Muscle Nerve 2009; 40:499-519. [PMID: 19705475 DOI: 10.1002/mus.21391] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The morphological and contractile changes of muscles below the level of the lesion after spinal cord injury (SCI) are dramatic. In humans with SCI, a fiber-type transformation away from type I begins 4-7 months post-SCI and reaches a new steady state with predominantly fast glycolytic IIX fibers years after the injury. There is a progressive drop in the proportion of slow myosin heavy chain (MHC) isoform fibers and a rise in the proportion of fibers that coexpress both the fast and slow MHC isoforms. The oxidative enzymatic activity starts to decline after the first few months post-SCI. Muscles from individuals with chronic SCI show less resistance to fatigue, and the speed-related contractile properties change, becoming faster. These findings are also present in animals. Future studies should longitudinally examine changes in muscles from early SCI until steady state is reached in order to determine optimal training protocols for maintaining skeletal muscle after paralysis.
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Affiliation(s)
- Bo Biering-Sørensen
- Clinic for Spinal Cord Injuries, NeuroScience Centre, Rigshospitalet, Copenhagen University Hospital, Havnevej 25, DK-3100 Hornbaek, Denmark.
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Gundogdu C, Aydin MD, Kotan D, Aydin N, Bayram E, Ulvi H, Aygul R. Vascular mechanism of axonal degeneration in peripheral nerves in hemiplegic sides after cerebral hemorrhage: An experimental study. J Brachial Plex Peripher Nerve Inj 2008; 3:13. [PMID: 18442382 PMCID: PMC2396626 DOI: 10.1186/1749-7221-3-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 04/28/2008] [Indexed: 11/23/2022] Open
Abstract
Background Though retrograde neuronal death and vascular insufficiency have been well established in plegics following intracerebral hemorrhage, the effects of plegia on arterial nervorums of peripheral nerves have not been reported. In this study, the histopathological effects of the intracerebral hemorrhage on the dorsal root ganglions and sciatic nerves via affecting the arterial nervorums were investigated. Methods This study was conducted on 13 male hybrid rabbits. Three animals were taken as control group and did not undergo surgery. The remaining 10 subjects were anesthetized and were injected with 0.50 ml of autologous blood into their right sensory-motor region. All rabbits were followed-up for two months and then sacrificed. Endothelial cell numbers and volume values were estimated a three dimensionally created standardized arterial nervorums model of lumbar 3. Neuron numbers of dorsal root ganglions, and axon numbers in the lumbar 3 nerve root and volume values of arterial nervorums were examined histopathologically. The results were analyzed by using a Mann-Whitney-U test. Results Left hemiplegia developed in 8 animals. On the hemiplegic side, degenerative vascular changes and volume reduction in the arterial nervorums of the sciatic nerves, neuronal injury in the dorsal root ganglions, and axonal injury in the lumbar 3 were detected. Statistical analyses showed a significant correlation between the normal or nonplegic sides and plegic sides in terms of the neurodegeneration in the dorsal root ganglions (p < 0.005), axonal degeneration in the lumbar 3 nerve roots (p < 0.005), endothelial cell degeneration in the arterial nervorums (p < 0.001), and volume reduction in the arterial nervorums (p < 0.001). Conclusion Intracerebral hemorrhage resulted in neurodegeneration in the dorsal root ganglion and axonolysis in the sciatic nerves, endothelial injury, and volume reduction of the arterial nervorums in the sciatic nerves. The interruption of the neural network connection in the walls of the arterial nervorums in the sciatic nerves may be responsible for circulation disorders of the arterial nervorums, and arterial nervorums degeneration could result in sciatic nerves injury.
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Affiliation(s)
- Cemal Gundogdu
- Department of Pathology, Medical Faculty, Ataturk University, Erzurum, Turkey.
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Ballaz L, Fusco N, Crétual A, Langella B, Brissot R. Acute peripheral blood flow response induced by passive leg cycle exercise in people with spinal cord injury. Arch Phys Med Rehabil 2007; 88:471-6. [PMID: 17398248 DOI: 10.1016/j.apmr.2007.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the acute femoral artery hemodynamic response in paraplegic subjects during a passive leg cycle exercise. DESIGN Case series. SETTING Department of physical medicine and rehabilitation in a university in France. PARTICIPANTS A volunteer sample of 15 people with traumatic spinal cord injury. INTERVENTION Subjects performed a 10-minute session of passive leg cycle exercise in the sitting position. MAIN OUTCOME MEASURES We measured heart rate, maximal (Vmax), and minimal femoral artery blood flow velocity at rest and immediately after the passive leg cycle exercise, using quantitative duplex Doppler ultrasound. We calculated mean blood flow velocity (Vmean) and velocity index, representing the peripheral resistance, for each condition. RESULTS Vmax and Vmean increased (from .80+/-.18 m/s to .96+/-.24 m/s, P<.01; and from .058+/-.02 m/s to .076+/-.03 m/s, P<.01; respectively) after 10 minutes of passive leg cycle exercise. Heart rate did not change. The velocity index decreased from 1.23+/-0.15 to 1.16+/-0.21 (P=.038). CONCLUSIONS The results of this study suggest that acute passive leg cycle exercise increases vascular blood flow velocity in paralyzed legs of people with paraplegia. This exercise could have clinical implications for immobilized persons.
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Affiliation(s)
- Laurent Ballaz
- Physiology and Biomechanics Laboratory, Sports Department, Rennes 2 University, France.
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Stoner L, Sabatier MJ, Mahoney ET, Dudley GA, McCully KK. Electrical stimulation-evoked resistance exercise therapy improves arterial health after chronic spinal cord injury. Spinal Cord 2006; 45:49-56. [PMID: 16718276 DOI: 10.1038/sj.sc.3101940] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Repeated measures training intervention. OBJECTIVES To evaluate the effects of neuromuscular electrical stimulation (NMES)-induced resistance exercise therapy on lower extremity arterial health in individuals with chronic, complete spinal cord injury (SCI). We define "arterial health" using three surrogate markers: (a) resting diameter, (b) flow-mediated dilation (FMD), and (c) arterial range. SETTING Department of Kinesiology, University of Georgia, USA. METHODS We assessed five 36+/-5-year-old male individuals with chronic, complete SCI before, during, and after 18 weeks of training. The quadriceps femoris muscle group of both legs were trained twice a week with 4 x 10 repetitions of unilateral, dynamic knee extensions. The health of the posterior tibial artery was assessed using a B-mode ultrasound unit equipped with a high-resolution video capture device. Proximal occlusion was used to evoke ischemia for 5 min and then for 10 min. FMD was calculated using the peak diameter change (above rest) following 5 min occlusion. Arterial range was calculated using minimum (during occlusion) and maximum diameters (post 10 min occlusion). Hierarchical linear modeling accounted for the nested (repeated measures) experimental design. RESULTS FMD improved from 0.08+/-0.11 mm (2.7%) to 0.18+/-0.15 mm (6.6%) (P=0.004), and arterial range improved from 0.36+/-0.28 to 0.94+/-0.40 mm (P=0.001), after 18 weeks of training. Resting diameter did not significantly change. CONCLUSIONS Home-based, self-administered NMES resistance exercise therapy consisting of 80 contractions/week improved FMD and arterial range. This provides evidence that resistance exercise therapy can improve arterial health after SCI, which may reduce the risk of future cardiovascular disease.
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Affiliation(s)
- L Stoner
- Department of Kinesiology, University of Georgia, Ramsey Center, Athens, GA 30602-6552, USA
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Higuchi Y, Kitamura S, Kawashima N, Nakazawa K, Iwaya T, Yamasaki M. Cardiorespiratory responses during passive walking-like exercise in quadriplegics. Spinal Cord 2005; 44:480-6. [PMID: 16317423 DOI: 10.1038/sj.sc.3101875] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross-sectional and comparative investigation using quadriplegics (QP) and nondisabled subjects (ND). OBJECTIVE To evaluate cardiorespiratory responses during passive walking-like exercise (PWE) in QP. SETTING National Rehabilitation Center for Persons with Disabilities in Japan. METHOD The subjects were seven male QP with complete lesion (age: 27.0 +/- 5.4, injured level: C6-C7) and six male ND (age: 26.3 +/- 4.5). Cardiorespiratory responses were measured until voluntary fatigue during PWE, the rhythmical activity of paralyzed lower limbs synchronized with arm movements. RESULTS There were no significant differences in oxygen consumption (VO(2)), pulmonary ventilation (VE), heart rate (HR) and oxygen pulse (O(2) pulse) between QP and ND during PWE. ND showed increased ventilatory equivalent for oxygen (VE/VO(2) ratio) during exercise, while QP showed a significantly greater respiratory rate (RR) during exercise than ND (P < 0.05). CONCLUSION PWE elicited an increase in VO(2) with workload increment in QP similar to ND. However, higher RR suggested the intrinsic dysfunction of RR control during submaximal exercise in QP. From these results, it was thought that respiratory response would be the restriction factor of efficient oxygen transportation during PWE in QP.
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Affiliation(s)
- Y Higuchi
- Department of Physical Training for Remedial Gymnastics, Hospital, National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Saitama, Japan
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Kawashima N, Nakazawa K, Akai M. Muscle Oxygenation of the Paralyzed Lower Limb in Spinal Cord???Injured Persons. Med Sci Sports Exerc 2005; 37:915-21. [PMID: 15947714 DOI: 10.1249/01.mss.0000170488.86528.08] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Even in the paralyzed lower limb muscle, EMG activity can be induced by imposing passive leg movement in standing posture in persons with spinal cord injury (SCI). The purpose of the present study was to ascertain whether the oxygenation level of the paralyzed lower limb muscle covaried with the muscle EMG activity during imposed passive leg movement. METHODS Six motor-complete SCI subjects and four neurologically normal controls were placed on a gait-training apparatus that enabled the SCI subjects to stand and move their legs passively. After a 1-min resting stage, consecutive passive alternate leg movements were performed at different frequencies (0.8, 1, 1.2, and 1 Hz, for 3 min at each stage). To obtain postexercise data, subjects were kept in a standing posture for 5 min after passive movement ceased. The EMG activity and concentration changes in the oxygenated (oxy-) and deoxygenated hemoglobin (Hb) (deoxy-Hb) were continuously measured using near-infrared spectroscopy (NIRS) from the gastrocnemius muscle. RESULTS In all SCI subjects, muscle EMG activity was observed during passive leg movement. The oxy-Hb level gradually increased, whereas the deoxy-Hb decreased, and these changes were independent of the total Hb changes. In the recovery stage, the total Hb level was found to exceed the preexercise level. In contrast to the SCI patients, the normal subjects showed neither EMG activity nor changes in oxy- or deoxy-Hb. CONCLUSION The present results demonstrate that passive leg movement can induce not only muscular activity but also alteration of muscle oxygenation level in the paralyzed lower leg. Particularly, induced muscular activity seems to correlate with increased perfusion of the muscle.
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Affiliation(s)
- Noritaka Kawashima
- Department of Rehabilitation for Movement Functions, Research Institute, National Rehabilitation Center for Persons with Disabilities, Saitama, Japan.
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Hagobian TA, Jacobs KA, Kiratli BJ, Friedlander AL. Foot Cooling Reduces Exercise-Induced Hyperthermia in Men with Spinal Cord Injury. Med Sci Sports Exerc 2004; 36:411-7. [PMID: 15076782 DOI: 10.1249/01.mss.0000117133.75146.66] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED The number of individuals with spinal cord injury (SCI) participating in sports at recreational and elite levels is on the rise. However, loss of autonomic nervous system function below the lesion can compromise thermoregulatory capacity and increase the risk of heat stress relative to able-bodied (AB) individuals. PURPOSE To test the hypotheses that exercise in a heated environment would increase tympanic temperature (TTY) more in individuals with SCI than AB individuals, and that foot cooling using a new device would attenuate the rise in TTY during exercise in both groups. METHODS Six subjects with SCI (lesions C5-T5) and six AB controls were tested in a heated environment (means +/- SEM, temperature = 31.8 +/- 0.2 degrees C, humidity = 26 +/- 1%) for 45 min at 66% +/- 5 of arm cranking VO2peak and 30 min of recovery on two separate occasions with foot cooling (FC) or no foot cooling (NC) in randomized order. RESULTS During exercise and recovery in both trials, SCI TTY was elevated above baseline (P < 0.001) but more so in the NC versus FC trial (1.6 +/- 0.2 degrees C vs 1.0 +/- 0.2 degrees C, respectively, P < 0.005). Within the AB group, TTY was elevated above baseline for both trials (P < 0.001) with peak increases of 0.5 +/- 0.2 degrees C and 0.3 +/- 0.2 degrees C for NC and FC, respectively. TTY, face, and back temperature were higher in both SCI trials compared with AB trials (P < 0.05). Heart rate during exercise and recovery was lower in the SCI FC versus SCI NC (P < 0.05). CONCLUSION These results suggest that extraction of heat through the foot may provide an effective way to manipulate tympanic temperature in individuals with SCI, especially during exercise in the heat.
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Affiliation(s)
- Todd A Hagobian
- Clinical Studies Unit, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
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Olive JL, Slade JM, Bickel CS, Dudley GA, McCully KK. Increasing blood flow before exercise in spinal cord-injured individuals does not alter muscle fatigue. J Appl Physiol (1985) 2004; 96:477-82. [PMID: 14506095 DOI: 10.1152/japplphysiol.00577.2003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Previous studies have shown increased fatigue in paralyzed muscle of spinal cord-injured (SCI) patients (Castro M, Apple D Jr, Hillegass E, and Dudley GA. Eur J Appl Physiol 80: 373-378, 1999; Gerrits H, Hopman MTE, Sargeant A, and de Haan A. Clin Physiol 21: 105-113, 2001). Our purpose was to determine whether the increased muscle fatigue could be due to a delayed rise in blood flow at the onset of exercise in SCI individuals. Isometric electrical stimulation was used to induce fatigue in the quadriceps femoris muscle of seven male, chronic (>1 yr postinjury), complete (American Spinal Injury Association, category A) SCI subjects. Cuff occlusion was used to elevate blood flow before electrical stimulation, and the magnitude of fatigue was compared with a control condition of electrical stimulation without prior cuff occlusion. Blood flow was measured in the femoral artery by Doppler ultrasound. Prior cuff occlusion increased blood flow in the first 30 s of stimulation compared with the No-Cuff condition (1,350 vs. 680 ml/min, respectively; P < 0.001), although blood flow at the end of stimulation was the same between conditions (1,260 ± 140 vs. 1,160 ± 370 ml/min, Cuff and No-Cuff condition, respectively; P = 0.511). Muscle fatigue was not significantly different between prior cuff occlusion and the control condition (32 ± 13 vs. 35 ± 10%; P = 0.670). In conclusion, increased muscle fatigue in SCI individuals is not associated with the prolonged time for blood flow to increase at the onset of exercise.
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Affiliation(s)
- Jennifer L Olive
- Department of Radiology, University of Washington, Seattle, Washington 98195, USA.
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McCully KK, Smith S, Rajaei S, Leigh JS, Natelson BH. Muscle metabolism with blood flow restriction in chronic fatigue syndrome. J Appl Physiol (1985) 2003; 96:871-8. [PMID: 14578362 PMCID: PMC2680353 DOI: 10.1152/japplphysiol.00141.2003] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to determine whether chronic fatigue syndrome (CFS) is associated with reduced blood flow and muscle oxidative metabolism. Patients with CFS according to Centers for Disease Control criteria (n = 19) were compared with normal sedentary subjects (n = 11). Muscle blood flow was measured in the femoral artery with Doppler ultrasound after exercise. Muscle metabolism was measured in the medial gastrocnemius muscle with (31)P-magnetic resonance spectroscopy. Muscle oxygen saturation and blood volume were measured using near-infrared spectroscopy. CFS and controls were not different in hyperemic blood flow or phosphocreatine recovery rate. Cuff pressures of 50, 60, 70, 80, and 90 mmHg were used to partially restrict blood flow during recovery. All pressures reduced blood flow and oxidative metabolism, with 90 mmHg reducing blood flow by 46% and oxidative metabolism by 30.7% in CFS patients. Hyperemic blood flow during partial cuff occlusion was significantly reduced in CFS patients (P < 0.01), and recovery of oxygen saturation was slower (P < 0.05). No differences were seen in the amount of reduction in metabolism with partially reduced blood flow. In conclusion, CFS patients showed evidence of reduced hyperemic flow and reduced oxygen delivery but no evidence that this impaired muscle metabolism. Thus CFS patients might have altered control of blood flow, but this is unlikely to influence muscle metabolism. Furthermore, abnormalities in muscle metabolism do not appear to be responsible for the CFS symptoms.
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Affiliation(s)
- Kevin K McCully
- Department of Exercise Science, University of Georgia, Athens, GA 30602, USA.
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Abstract
PURPOSE Our purpose was to determine whether spinal cord injured (SCI) subjects have decreased femoral artery diameter and maximal hyperemic blood flow when expressed per unit of muscle volume compared with able-bodied (AB) individuals. A secondary purpose was to determine whether blood flow recovery rates were similar between groups. METHODS Blood flow was measured in the femoral artery using Doppler ultrasound after distal thigh cuff occlusion of 4 and 10 min. Muscle mass of the lower leg was determined by magnetic resonance imaging (MRI). RESULTS SCI individuals had smaller muscle cross-sectional areas (37%, P = 0.001) and volumes (38%, P = 0.001) than AB individuals. Furthermore, femoral artery diameter (0.76 +/- 0.14 vs 0.48 +/- 0.06 cm, AB vs SCI, P < 0.001) and femoral artery maximal blood flow (2050 +/- 520 vs 1220 +/- 240 mL x min-1, AB vs SCI, P < 0.001) were lower in SCI than AB individuals. Femoral artery diameter and maximal blood flow per unit muscle volume did not differ between SCI and AB individuals (P = 0.418 and P = 0.891, respectively). Blood flow recovery after ischemia was prolonged in SCI compared with AB individuals for both cuff durations (P = 0.048). CONCLUSIONS In summary, femoral artery diameter and maximal hyperemic blood flow response per unit muscle volume are not different between SCI and AB individuals. Vascular atrophy after SCI appears to be closely linked to muscle atrophy. Furthermore, the SCI compared with AB individuals had a prolonged time to recovery, which may suggest decreased vessel reactivity.
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Affiliation(s)
- Jennifer L Olive
- University of Georgia, Department of Exercise Science, Athens 30602, USA
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Olive JL, DeVan AE, McCully KK. The effects of aging and activity on muscle blood flow. DYNAMIC MEDICINE : DM 2002; 1:2. [PMID: 12605712 PMCID: PMC150384 DOI: 10.1186/1476-5918-1-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2002] [Accepted: 12/19/2002] [Indexed: 01/11/2023]
Abstract
BACKGROUND Our purpose was to determine if aging had an influence on muscle blood flow independent of habitual physical activity levels. METHODS Blood flow was measured in the femoral artery by Doppler ultrasound after cuff occlusion of 10 minutes. Active and inactive older subjects (73 +/- 7 years) were compared to active and inactive young subjects (26 +/- 6 years). RESULTS Peak blood flow capacity when normalized to lean muscle mass was related to activity level (p < 0.001), but not to age. Specifically, the young active group had higher peak blood flows than the young inactive (p = 0.031) or older inactive (p = 0.005) groups. Resting blood flow and conductance were not significantly different between groups. Mean arterial pressure was significantly higher in the older compared to young group (p = 0.002). Conductance was related to both activity (p = 0.002) and age (p = 0.003). A prolonged time for blood flow to recover was found in the older compared to the young group (p = 0.038) independent of activity status. CONCLUSIONS The prolonged recovery time in the older subjects may suggest a reduced vascular reactivity associated with increased cardiovascular disease risk. Peak blood flow capacity is maintained in older subjects by physical activity. In summary, maximal flow capacity and prolonged recovery of blood flow are influenced by different mechanisms in young and older active and inactive subjects.
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Affiliation(s)
- Jennifer L Olive
- University of Georgia, Department of Exercise Science, Athens, GA 30602
- Current address: University of Washington Medical School, Department of Radiology, Seattle, WA
| | - Allison E DeVan
- University of Georgia, Department of Exercise Science, Athens, GA 30602
- Current address: University of Texas, Department of Exercise Science, Austin, TX
| | - Kevin K McCully
- University of Georgia, Department of Exercise Science, Athens, GA 30602
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