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Keightley JGA, Haagman B, Magner JD, Debenham JR. Models of care for musculoskeletal shoulder pain in spinal cord injury: A scoping review. J Spinal Cord Med 2024; 47:327-344. [PMID: 36913538 PMCID: PMC11044743 DOI: 10.1080/10790268.2023.2183335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
CONTEXT Spinal cord injury (SCI) is a neurological condition that significantly impacts a person's lifestyle, health and well-being. Many individuals with SCI experience secondary musculoskeletal shoulder pain. This scoping review examines the current research on the diagnosis and management of shoulder pain in SCI. OBJECTIVE The aim of this Scoping Review was (1) to chart peer-reviewed literature regarding the diagnosis and management of shoulder pain as it relates to SCI and (2) identify gaps in this body of literature to inform future research priorities. METHODS Six electronic databases were searched from inception until April 2022. In addition, reviewers scanned the reference lists of identified articles. Articles from peer-reviewed sources that reported diagnostic or management procedures for musculoskeletal shoulder conditions within the SCI population were considered and 1679 articles were identified. Title and abstract screening, full text review, and data extraction were undertaken by two independent reviewers. RESULTS Eighty seven articles were included, covering diagnosis or management of shoulder pain in SCI. CONCLUSION Whilst the most commonly reported diagnostic procedures and management strategies reflect contemporary practice for shoulder pain, the entire body of literature demonstrates inconsistencies in methodologies. In places, the literature continues to perceive value in procedures inconsistent with best practice. These findings encourage researchers to pursue the development of robust models of care for musculoskeletal shoulder pain in SCI using a collaborative and integrated approach, combining best practice for musculoskeletal shoulder pain alongside clinical expertise in the management of SCI.
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Affiliation(s)
- Jordan G. A. Keightley
- National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Active Linc (Home Based Services), Innaloo, Western Australia, Australia
| | - Bianca Haagman
- National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Active Linc (Home Based Services), Innaloo, Western Australia, Australia
| | - Julie D. Magner
- Active Linc (Home Based Services), Innaloo, Western Australia, Australia
| | - James R. Debenham
- National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Active Linc (Home Based Services), Innaloo, Western Australia, Australia
- Majarlin Kimberley Centre for Remote Health, The University of Notre Dame Australia, Broome, Western Australia, Australia
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Arora T, Liu J, Mohan A, Li X, O'laughlin K, Bennett T, Nemunaitis G, Bethoux F, Pundik S, Forrest G, Kirshblum S, Kilgore K, Bryden A, Kristi Henzel M, Wang X, Baker K, Brihmat N, Bayram M, Plow EB. Corticospinal inhibition investigated in relation to upper extremity motor function in cervical spinal cord injury. Clin Neurophysiol 2024; 161:188-197. [PMID: 38520799 DOI: 10.1016/j.clinph.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/29/2023] [Accepted: 02/22/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE Corticospinal inhibitory mechanisms are relevant to functional recovery but remain poorly understood after spinal cord injury (SCI). Post-injury characteristics of contralateral silent period (CSP), a measure of corticospinal inhibition evaluated using transcranial magnetic stimulation (TMS), is inconsistent in literature. We envisioned that investigating CSP across muscles with varying degrees of weakness may be a reasonable approach to resolve inconsistencies and elucidate the relevance of corticospinal inhibition for upper extremity function following SCI. METHODS We studied 27 adults with chronic C1-C8 SCI (age 48.8 ± 16.1 years, 3 females) and 16 able-bodied participants (age 33.2 ± 11.8 years, 9 females). CSP characteristics were assessed across biceps (muscle power = 3-5) and triceps (muscle power = 1-3) representing stronger and weaker muscles, respectively. We assessed functional abilities using the Capabilities of the Upper Extremity Test (CUE-T). RESULTS Participants with chronic SCI had prolonged CSPs for biceps but delayed and diminished CSPs for triceps compared to able-bodied participants. Early-onset CSPs for biceps and longer, deeper CSPs for triceps correlated with better CUE-T scores. CONCLUSIONS Corticospinal inhibition is pronounced for stronger biceps but diminished for weaker triceps muscle in SCI indicating innervation relative to the level of injury matters in the study of CSP. SIGNIFICANCE Nevertheless, corticospinal inhibition or CSP holds relevance for upper extremity function following SCI.
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Affiliation(s)
- Tarun Arora
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, OH, USA; Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Norway
| | - Jia Liu
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, OH, USA
| | - Akhil Mohan
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, OH, USA
| | - Xin Li
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, OH, USA
| | - Kyle O'laughlin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, OH, USA
| | - Teale Bennett
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, OH, USA
| | - Gregory Nemunaitis
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic Foundation, OH, USA
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic Foundation, OH, USA
| | - Svetlana Pundik
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio, USA; Department of Neurology, Case Western Reserve University School of Medicine, Cleveland OH, USA
| | - Gail Forrest
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA
| | - Steven Kirshblum
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA; Kessler Institute for Rehabilitation, West Orange, New Jersey, USA; Kessler Foundation, West Orange, New Jersey, USA
| | - Kevin Kilgore
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio, USA; Department of Physical Medicine and Rehabilitation, MetroHealth Center for Rehabilitation Research, OH, USA; Institute for Functional Restoration, Case Western Reserve University, Cleveland, OH, USA
| | - Anne Bryden
- Department of Physical Medicine and Rehabilitation, MetroHealth Center for Rehabilitation Research, OH, USA; Institute for Functional Restoration, Case Western Reserve University, Cleveland, OH, USA
| | - M Kristi Henzel
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland OH, USA
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, OH, USA
| | - Kelsey Baker
- Department of Neuroscience, School of Medicine, University of Texas RioGrande Valley, RioGrande Valley, TX, USA
| | - Nabila Brihmat
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA
| | - Mehmed Bayram
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, New Jersey, USA
| | - Ela B Plow
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, OH, USA; Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic Foundation, OH, USA; Cleveland Clinic Rehabilitation Hospitals, Cleveland, OH, USA.
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Vasquez LO, Lee I, Bart J, Barton CR, Chui J, Tascione O, Kumar NS, Cirnigliaro CM, Lombard AT, Kirshblum SC, Bauman WA, Handrakis JP. Self-reported effects of warm seasonal temperatures in persons with spinal cord injury. J Spinal Cord Med 2024; 47:395-403. [PMID: 37010833 PMCID: PMC11044722 DOI: 10.1080/10790268.2023.2194962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE Spinal cord injury (SCI) interrupts motor, sensory, and autonomic pathways, impairing mobility and increasing heat storage during warm seasonal temperatures due to compromised autonomic control of vasodilation and sweating and recognition of body temperature. Thus, persons with SCI are more vulnerable to hyperthermia and its adverse effects. However, information regarding how persons with SCI perceive warmer seasons and whether thermal discomfort during warmer seasons restricts routine activities remains anecdotal. DESIGN Cross-sectional, self-report surveys. SETTING VA Medical Center and Kessler Institute for Rehabilitation. PARTICIPANTS Three groups of 50 participants each: tetraplegia, paraplegia, and matched non-SCI controls. OUTCOME MEASURES Tetraplegia, paraplegia, and control groups responded "yes" or "no" when asked whether warm seasonal temperatures adversely affected comfort or participation in routine activities. RESULTS The percentage of responses differed among tetraplegia, paraplegia, and control groups when asked if they required ≥20 min to cool down once overheated (44 vs. 20 vs. 12%; X2 = 14.7, P < 0.001), whether heat-related discomfort limited their ability to go outside (62 vs. 34 vs. 32%; X2 = 11.5, P = 0.003), if they needed to use a water-mister because of the heat (70 vs. 44 vs. 42%; X2 = 9.8, P = 0.008), and if heat-related discomfort limited participation in social activities (40 vs. 20 vs. 16%; X2 = 8.7, P = 0.01). CONCLUSION Warmer seasonal temperatures had a greater negative impact on reported comfort and daily activities of persons with SCI than non-SCI controls. Those with tetraplegia were most adversely affected. Our findings warrant increasing awareness and identifying interventions to address the vulnerability of persons with SCI to hyperthermia.
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Affiliation(s)
- Luis Ortiz Vasquez
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Ingrid Lee
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Jessica Bart
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Physical Therapy, School of Health Professions, New York Institute of Technology, Old Westbury, New York, USA
| | - Christian R. Barton
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Physical Therapy, School of Health Professions, New York Institute of Technology, Old Westbury, New York, USA
| | - Jennifer Chui
- Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Oriana Tascione
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Nina S. Kumar
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Christopher M. Cirnigliaro
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Alex T. Lombard
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Steven C. Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersey, USA
- Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - William A. Bauman
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John P. Handrakis
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Physical Therapy, School of Health Professions, New York Institute of Technology, Old Westbury, New York, USA
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Cyriëlle S, Alex VB, Nadine H. Surgical procedures to improve hand function in tetraplegic patients: patient satisfaction and outcomes over a 20-year period. J Hand Surg Eur Vol 2024:17531934241246459. [PMID: 38641944 DOI: 10.1177/17531934241246459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
The aim of the present study was to report our experience in the evolution in surgical strategy and patient satisfaction after upper limb reconstruction in tetraplegic patients. A total of 72 patients (114 upper limbs) underwent surgery between 1997 and 2017. Since April 2003, tenodesis of the extensor digitorum communis tendons was no longer performed because it limited wrist flexion, and two-stage operations to restore active grasp were replaced by one-stage procedures. In total, 34 patients (58 upper limbs) completed questionnaires about function and satisfaction at a mean follow-up of 14 years (range 4-24) since their first operation; 26 were satisfied, 30 would have the operation again and 31 benefitted from the surgery. Surgical procedures, such as tendon transfers, arthrodesis and tenodesis, can have a positive effect on patient-perceived function and satisfaction in the long term in most of these patients.Level of evidence: IV.
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Affiliation(s)
- Stevens Cyriëlle
- Ghent University Hospital, Ghent, Belgium
- Sint Jozefskliniek, Izegem, Belgium
| | - Vanden Berghe Alex
- Ghent University Hospital, Ghent, Belgium
- Sint Jozefskliniek, Izegem, Belgium
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Lv D, Wu C, Qiu D, Huang R. A case of iatrogenic acute spinal cord injury with tetraplegia following thyroid surgery. Am J Otolaryngol 2024; 45:104305. [PMID: 38653085 DOI: 10.1016/j.amjoto.2024.104305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
AIM Iatrogenic acute spinal cord injury with tetraplegia is a serious consequence of non-spinal surgery.We report a case of acute spinal cord injury with tetraplegia after thyroid surgery. METHOD The patient was pathologically diagnosed with papillary carcinoma, underwent left thyroidectomy, and developed tetraplegia after surgery. RESULT The patient was diagnosed with acute spinal cord injury with tetraplegia and cured after anti-inflammatory and dehydrating treatment. CONCLUSION Iatrogenic spinal cord injuries after elective non-spinal surgery can have catastrophic consequences, and clinicians must be alert to this possibility in clinical practice.
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Affiliation(s)
- Dacheng Lv
- Department of Spinal Surgery, Yancheng Branch of Nanjing Drum Tower Hospital, Yancheng, Jiangsu Province, China
| | - Chunyan Wu
- Department of Neurology, Yancheng Branch of Nanjing Drum Tower Hospital, Yancheng, Jiangsu Province, China
| | - Dening Qiu
- Department of Thyroid and Breast Surgery, Yancheng Branch of Nanjing Drum Tower Hospital, Yancheng, Jiangsu Province, China
| | - Renhua Huang
- Department of Spinal Surgery, Yancheng Branch of Nanjing Drum Tower Hospital, Yancheng, Jiangsu Province, China.
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Mateo S, Guillot A, Henkous S, Gelis A, Daligault S, Rode G, Collet C, Di Rienzo F. Implicit and explicit motor imagery ability after SCI: Moving the elbow makes the difference. Brain Res 2024; 1836:148911. [PMID: 38604558 DOI: 10.1016/j.brainres.2024.148911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/23/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
Cervical spinal cord injury (SCI) causes dramatic sensorimotor deficits that restrict both activity and participation. Restoring activity and participation requires extensive upper limb rehabilitation focusing elbow and wrist movements, which can include motor imagery. Yet, it remains unclear whether MI ability is impaired or spared after SCI. We investigated implicit and explicit MI ability in individuals with C6 or C7 SCI (SCIC6 and SCIC7 groups), as well as in age- and gender-matched controls without SCI. Inspired by previous studies, implicit MI evaluations involved hand laterality judgments, hand orientation judgments (HOJT) and hand-object interaction judgments. Explicit MI evaluations involved mental chronometry assessments of physically possible or impossible movements due to the paralysis of upper limb muscles in both groups of participants with SCI. HOJT was the paradigm in which implicit MI ability profiles differed the most between groups, particularly in the SCIC6 group who had impaired elbow movements in the horizontal plane. MI ability profiles were similar between groups for explicit MI evaluations, but reflected task familiarity with higher durations in the case of unfamiliar movements in controls or attempt to perform movements which were no longer possible in persons with SCI. Present results, obtained from a homogeneous population of individuals with SCI, suggest that people with long-term SCI rely on embodied cognitive motor strategies, similar to controls. Differences found in behavioral response pattern during implicit MI mirrored the actual motor deficit, particularly during tasks that involved internal representations of affected body parts.
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Affiliation(s)
- Sébastien Mateo
- Universite Lyon, UCBL-Lyon 1, INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Trajectoires Team, Centre Hospitalier Le Vinatier, Bâtiment 452, 95 Boulevard Pinel, F-69675 Bron, Auvergne-Rhône-Alpes, France; Lyon Neuroscience Research Center, Trajectoires Team, Centre Hospitalier Le Vinatier, Bâtiment 452, 95 Boulevard Pinel, F-69675 Bron, Auvergne-Rhône-Alpes, France
| | - Aymeric Guillot
- Hospices Civils de Lyon, Hôpital Henry Gabrielle, Plate-forme Mouvement et Handicap, 20 route de Vourles, F-69230, Saint Genis Laval, Auvergne-Rhône-Alpes, France
| | - Sonia Henkous
- Hospices Civils de Lyon, Hôpital Henry Gabrielle, Plate-forme Mouvement et Handicap, 20 route de Vourles, F-69230, Saint Genis Laval, Auvergne-Rhône-Alpes, France
| | - Anthony Gelis
- Universite Lyon, UCBL-Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité, UR 7424, 27-29 Boulevard du 11 Novembre 1918, F-69622 Villeurbanne, Auvergne-Rhône-Alpes, France
| | - Sébastien Daligault
- Centre Mutualiste Neurologique Propara, 263 rue du Caducée, F-34090, Montpellier, Occitanie, France; CERMEP, Imagerie du Vivant, 95 Boulevard Pinel, F-69677 Bron, Auvergne-Rhône-Alpes, France
| | - Gilles Rode
- Universite Lyon, UCBL-Lyon 1, INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Trajectoires Team, Centre Hospitalier Le Vinatier, Bâtiment 452, 95 Boulevard Pinel, F-69675 Bron, Auvergne-Rhône-Alpes, France; Lyon Neuroscience Research Center, Trajectoires Team, Centre Hospitalier Le Vinatier, Bâtiment 452, 95 Boulevard Pinel, F-69675 Bron, Auvergne-Rhône-Alpes, France
| | - Christian Collet
- Hospices Civils de Lyon, Hôpital Henry Gabrielle, Plate-forme Mouvement et Handicap, 20 route de Vourles, F-69230, Saint Genis Laval, Auvergne-Rhône-Alpes, France
| | - Franck Di Rienzo
- Hospices Civils de Lyon, Hôpital Henry Gabrielle, Plate-forme Mouvement et Handicap, 20 route de Vourles, F-69230, Saint Genis Laval, Auvergne-Rhône-Alpes, France.
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Stilwell G, Symons D, Gooch S, Dunn J. Comparison of multidirectional upper limb strength for non-disabled individuals and individuals with C4-C7 spinal cord injury in a seated position. Ergonomics 2024:1-11. [PMID: 38456824 DOI: 10.1080/00140139.2024.2325536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
This study investigates the multidirectional upper limb strength of individuals with a C4-C7 spinal cord injury (SCI) and non-disabled individuals in a seated position by measuring multidirectional force at the hand. Current literature lacks quantitative strength data to evaluate strength requirements for people who have reduced upper limb function due to a cervical SCI. Seated multidirectional force measurements were recorded for eleven non-disabled and ten males with a C4-C7 SCI. Collected data was displayed using detailed force polar plots. The resulting plots revealed a clear difference in polar plot shape for non-disabled participants and participants with a C4-C7 SCI. Namely that SCI participants had more elliptical polar plots due to reductions in circumferential strength compared to non-disabled participants. However, the polar plots for higher SCIs tended to have an increasingly more circular shape. The results provide insight into the differences in strength between people with cervical SCI and no disability.
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Affiliation(s)
- George Stilwell
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Digby Symons
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Shayne Gooch
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Jennifer Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Dunedin, New Zealand
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Mansi Z, Rbai H, Saibi F, Saadana J, Chermiti W, Zaidi B. Our experience with the surgical management of lower cervical spine fractures: fifty case series. Int Orthop 2024; 48:817-830. [PMID: 38182851 DOI: 10.1007/s00264-023-06076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/16/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE Trauma to the lower cervical spine is a serious lesion due to its neurological consequences which jeopardize the vital and functional prognosis. They constitute a public health problem due to their frequency and seriousness requiring rapid and adequate treatment. The aim of our study is to (1) describe the epidemiological, clinical, and radiological characteristics of lower cervical spine trauma patients; (2) support the therapeutic management of these patients and show our experience in surgery for lower cervical spine trauma; and (3) analyze the anatomical and functional results and discuss them with literature data. METHODS This is a retrospective descriptive study of 50 patients with lower cervical spine trauma treated surgically over a period of five years from January 1, 2016, to December 2020. RESULTS The average age of our patients was 34.5 years, with a sex ratio of 1.7. The etiologies are dominated by accidents on public roads (58%). They show neurological disorders such as spinal cord damage in 30% of cases and root damage in 20% of cases. The radiological assessment revealed eight tear drops, ten comminuted fractures, 12 severe sprains, 12 biarticular dislocations, six uniarticular dislocations, and two herniated discs. Treatment was surgical in all patients with an anterolateral approach and anterior arthrodesis. The evolution was favourable in 21 patients and stationary in 29 patients. CONCLUSION Our study concluded that dislocations and fracture dislocations were the predominant type of injury in cases of AVP. Tetraplegia was mainly observed with uni- and biarticular dislocations. The variation in consolidation time was not correlated with trauma-to-surgery time. Better neurological recovery was observed with mild initial neurological damage than with initially severe damage. The appearance of an adjacent syndrome is less frequent with monosegmental arthrodesis than with multisegmental arthrodesis. Cage arthrodesis was an alternative to iliac harvesting with similar results.
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Affiliation(s)
- Zied Mansi
- University of Sousse, Sousse, Tunisia.
- Tunisian Society of Orthopaedic and Traumatolgy Surgery, Tunis, Tunisia.
| | - Hedi Rbai
- University of Sousse, Sousse, Tunisia
- Tunisian Society of Orthopaedic and Traumatolgy Surgery, Tunis, Tunisia
| | - Firas Saibi
- University of Sousse, Sousse, Tunisia
- Tunisian Society of Orthopaedic and Traumatolgy Surgery, Tunis, Tunisia
| | - Jacem Saadana
- Tunisian Society of Orthopaedic and Traumatolgy Surgery, Tunis, Tunisia
- University of Monastir, Monastir, Tunisia
| | - Wajdi Chermiti
- University of Sousse, Sousse, Tunisia
- Tunisian Society of Orthopaedic and Traumatolgy Surgery, Tunis, Tunisia
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Francoisse CA, Peters BR, Curtin CM, Novak CB, Russo SA, Tam K, Ota DT, Stenson KC, Steeves JD, Kennedy CR, Fox IK. Comparing surgeries to restore upper extremity function in tetraplegia: Impact on function during the perioperative period. J Spinal Cord Med 2024:1-12. [PMID: 38232181 DOI: 10.1080/10790268.2023.2283238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
CONTEXT/OBJECTIVE To assess short-term changes in health outcomes in people with cervical-level spinal cord injury (SCI) who underwent upper extremity (UE) reconstruction via either novel nerve transfer (NT) or traditional tendon transfer (TT) surgery with individuals who did not undergo UE surgical reconstruction. DESIGN Prospective, comparative cohort pilot study. PARTICIPANTS 34 participants with cervical SCI met the following inclusion criteria: age 18 or older, greater than 6 months post-injury, and mid-cervical level SCI American Spinal Injury Association Impairment Scale (AIS) A, B or C. SETTING Two tertiary academic hospitals and their affiliated veterans' hospitals. METHODS Health outcomes were assessed using two previously validated measures, the Spinal Cord Independence Measure (SCIM) and Short-Form Health Survey (SF-36). Demographic, surgical, and survey data were collected at the initial evaluation and one month postoperatively/post-baseline. RESULTS 34 participants with cervical SCI were recruited across three cohorts: no surgery (n = 16), NT (n = 10), and TT (n = 8). The TT group had a decline in SCIM and SF-36 scores whereas the NT and no surgery groups experienced little change in independence or health status in the immediate perioperative period. CONCLUSIONS Surgeons and rehabilitation providers must recognize differences in the perioperative needs of people with cervical SCI who chose to have restorative UE surgery. Future work should focus on further investigation of health outcomes, change in function, and improving preoperative counseling and cross-disciplinary management.
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Affiliation(s)
| | - Blair R Peters
- Division of Plastic Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Christine B Novak
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie A Russo
- Department of Orthopedic Surgery, Akron Children's Hospital, Akron, Ohio, USA
| | - Katharine Tam
- St. Louis Veterans' Healthcare System, St. Louis, Missouri, USA
- Division of Physical Medicine and Rehabilitation, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Doug T Ota
- Palo Alto Veterans Healthcare System, Palo Alto, California, USA
| | - Katherine C Stenson
- St. Louis Veterans' Healthcare System, St. Louis, Missouri, USA
- Division of Physical Medicine and Rehabilitation, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John D Steeves
- ICORD, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carie R Kennedy
- Division of Plastic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ida K Fox
- St. Louis Veterans' Healthcare System, St. Louis, Missouri, USA
- Division of Plastic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Di Giulio F, Castellini C, Tienforti D, Felzani G, Baroni MG, Barbonetti A. Independent association of hypovitaminosis d with non-alcoholic fatty liver disease in people with chronic spinal cord injury: a cross-sectional study. J Endocrinol Invest 2024; 47:79-89. [PMID: 37273143 DOI: 10.1007/s40618-023-02124-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/27/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE Non-alcoholic fatty liver disease (NAFLD) and hypovitaminosis D are highly prevalent in people with spinal cord injury (SCI) and could exert an unfavorable influence on cardiovascular profile and rehabilitation outcomes. We aimed to assess the independent association between low 25-hydroxy vitamin D (25(OH)D) levels and NAFLD in people with chronic (> 1 year) SCI. METHODS One hundred seventy-three consecutive patients with chronic SCI (132 men and 41 women) admitted to a rehabilitation program underwent clinical/biochemical evaluations and liver ultrasonography. RESULTS NAFLD was found in 105 patients (60.7% of the study population). They were significantly older and exhibited a poorer leisure time physical activity (LTPA) and functional independence in activities of daily living, a greater number of comorbidities and a higher prevalence of metabolic syndrome (MetS) and its correlates, including lower HDL and higher values of body mass index (BMI), systolic blood pressure, HOMA-index of insulin resistance and triglycerides. 25(OH)D levels were significantly lower in NAFLD (median: 10.6 ng/ml, range: 2.0-31.0) than in non-NAFLD group (22.5 ng/ml, 4.2-51.6). When all these variables were included in a multiple logistic regression analysis, a significant independent association with NAFLD only persisted for lower 25(OH)D levels, a greater number of comorbidities and a poorer LTPA. The ROC analysis revealed that 25(OH)D levels < 18.25 ng/ml discriminated patients with NAFLD with a sensitivity of 89.0% and a specificity of 73.0% (AUC: 85.7%; 95%CI: 79.6-91.7%). NAFLD was exhibited by 83.9% of patients with 25(OH)D levels < 18.25 ng/ml and by 18% of those with 25(OH)D levels ≥ 18.25 ng/ml (p < 0.0001). CONCLUSION In people with chronic SCI, 25(OH)D levels < 18.25 ng/ml may represent a marker of NAFLD independent of MetS-related features. Further studies are warranted to define the cause-effect relationships of this association.
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Affiliation(s)
- F Di Giulio
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - C Castellini
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - D Tienforti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - G Felzani
- Spinal Unit, San Raffaele Sulmona Institute, Sulmona, Italy
| | - M G Baroni
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, Italy
| | - A Barbonetti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
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Mueller G, Berlowitz DJ, Raab AM, Postma K, Gobets D, Huber B, Hund-Georgiadis M, Jordan X, Schubert M, Wildburger R, Brinkhof MWG. Incidence and Risk Factors of Pneumonia in Individuals With Acute Spinal Cord Injury: A Multi-national, Multi-center, Prospective Cohort Study. Arch Phys Med Rehabil 2023:S0003-9993(23)00647-0. [PMID: 38032554 DOI: 10.1016/j.apmr.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To describe the occurrence of pneumonia in individuals with acute spinal cord injury (SCI) and identify its key predictors. DESIGN Multi-centric, longitudinal cohort study. SETTING 10 specialized SCI rehabilitation units in Europe and Australia. PARTICIPANTS Eligible were 902 men and women with acute SCI, aged 18 years or older, with cervical or thoracic lesions and not dependent on 24-hour mechanical ventilation; 503 participated in the study (N=503). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We assessed demographics and lesion related parameters at study entry, and any pneumonia events throughout inpatient rehabilitation. Respiratory function, decubitus, and urinary tract infections were assessed at 1, 3, and 6 months post injury as well as at discharge from inpatient rehabilitation. Time to event (pneumonia) analyses were done using the Kaplan-Meier method, and potential predictors for pneumonia were analyzed with multivariable survival models. RESULTS Five hundred three patients with SCI were included, with 70 experiencing at least 1 pneumonia event. 11 participants experienced 2 or more events during inpatient rehabilitation. Most events occurred very early after injury, with a median of 6 days. Pneumonia risk was associated with tetraplegia (hazard ratio [HR]=1.78; 95% confidence interval [CI] 1.00-3.17) and traumatic etiology (HR=3.75; 95% CI 1.30-10.8) American Spinal Injury Impairment Scale (AIS) A (HR=5.30; 95% CI 2.28-12.31), B (HR=4.38; 95% CI 1.77-10.83), or C (HR=4.09; 95% CI 1.71-9.81) lesions. For every 10 cmH2O increase in inspiratory muscle strength, pneumonia risk was reduced by 13% (HR=0.87; 95% CI 0.78-0.97). CONCLUSION Pneumonia is a major complication after SCI with the highest incidence very early after injury. Individuals with traumatic or AIS A, B, or C tetraplegia are at highest risk for pneumonia.
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Affiliation(s)
- Gabi Mueller
- Swiss Paraplegic Research, Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | - David J Berlowitz
- Institute for Breathing and Sleep and the University of Melbourne, Austin Health, Melbourne, Australia
| | - Anja M Raab
- School of Health Professions of Bern University of Applied Sciences, Switzerland
| | - Karin Postma
- Rijndam Rehabilitation, Rotterdam, The Netherlands; Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David Gobets
- Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
| | | | | | | | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | | | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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12
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Jaramillo JP, Johanson ME, Kiratli BJ. Adherence and perceptions of a home sports video gaming program in persons with spinal cord injuries: A pilot study. J Spinal Cord Med 2023:1-11. [PMID: 37975789 DOI: 10.1080/10790268.2023.2268328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Sports video-gaming can facilitate increased activity levels in persons with limited exercise options. Understanding how persons with spinal cord injuries (SCI) participate in home-based video-gaming and its potential impact on maintaining or enhancing physical function remains largely unexplored. The purpose of this study was to evaluate adherence, perceptions, and potential physical effects of a home sports video-game program for persons with chronic SCI. PARTICIPANTS Fourteen individuals with chronic SCI (9 tetraplegia, 5 paraplegia). DESIGN This was a prospective study. Wii video-gaming systems that included four sports games were provided to participants for home use. Participants were instructed to play for 8 weeks 3-4 days/week. The video consoles recorded the time and number of sessions played. OUTCOME MEASURES At baseline and at the conclusion of the program, measurements were made of upper extremity strength, perceived exertion, active heart rate, pain, balance, and a functional upper extremity (UE) test. The total time and number of sessions were compared to the prescribed game play as a measure of adherence. Scores from a self-reported survey were used to gauge participants' satisfaction and perceptions of their gaming experience. RESULTS Overall mean gaming adherence was 85% during the first 4 weeks and 69% for the second 4 weeks. There were no significant changes in upper extremity strength, active heart rate, balance, pain, or functional UE test for either group. All of the participants rated video gaming as enjoyable and 85.7% perceived that it could be used as a form of exercise. CONCLUSION The Wii sports home video-gaming intervention elicited overall high adherence rates and was well received by study participants indicating that it may have value as an adjunctive tool for increasing physical activity for individuals with SCI.
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Affiliation(s)
- Jeffrey P Jaramillo
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - M Elise Johanson
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA
- University of California San Francisco, San Francisco State University Graduate Program in Physical Therapy, San Francisco, California, USA
| | - B Jenny Kiratli
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA
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13
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Anne Sinnott Jerram K, Dunn JA, Smaill RP, Middleton JW. International Classification of Function, Disability and Health (ICF) Word Mapping to Determine the Human Functioning Associated with Upper Extremity Surgery for Tetraplegia. J Patient Exp 2023; 10:23743735231211886. [PMID: 38026063 PMCID: PMC10631323 DOI: 10.1177/23743735231211886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Understanding human functioning and disablement, the contributing factors and their interactions in individuals with tetraplegia is important since elective upper extremity (UE) reconstructive surgery is now offered earlier after injury prior to full recognition of what lies ahead. Qualitative and quantitative data were available from a prior series of mixed methods studies, including a case series design capturing the patients' lived-experience perspectives of nerve or tendon transfer surgery, or not as the case may be. The objective of this study was to perform secondary data analysis to determine whether the recommended outcome tools being used by clinicians reflect the all important domains of functioning identified by people with tetraplegia who were considering UE reconstructive procedures. The original 18 candidate themes derived from qualitative analysis were reviewed in retrospect, along with a content analysis of the tools' questions, undertaking word mapping links to the ICF taxonomy. The outcomes tools included in the content analysis were the Canadian Occupational Performance Measure, the Capabilities of Upper Extremity Questionnaire, The Personal Wellbeing Index, and the Grasp and Release Test. Comparison between clinical outcomes tools and the patient lived-experience data uniquely identified links to Chapter1 (b) Mental functions, which include consciousness, orientation, temperament/personality, energy/drive, and higher-level cognition.
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Affiliation(s)
- K Anne Sinnott Jerram
- John Walsh Centre for Rehabilitation Research, Kolling Institute, St Leonards, NSW, Australia
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Burwood Academy of Trust, Christchurch, New Zealand
| | - Jennifer A Dunn
- Department of Orthopedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | | | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Kolling Institute, St Leonards, NSW, Australia
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Carlozzi NE, Kallen MA, Morin KG, Fyffe DC, Wecht JM. Item Banks for Measuring the Effect of Blood Pressure Dysregulation on Health-Related Quality of Life in Persons With Spinal Cord Injury. Arch Phys Med Rehabil 2023; 104:1872-1881. [PMID: 37172674 DOI: 10.1016/j.apmr.2023.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/24/2023] [Accepted: 04/15/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To report on the development and calibration of the new Blood Pressure Dysregulation Measurement System (BPD-MS) item banks that assess the effect of BPD on health-related quality of life (HRQOL) and the daily activities of Veterans and non-Veterans with spinal cord injury (SCI). DESIGN Cross-sectional survey study. SETTING Two Veteran Affairs medical centers and a SCI model system site. PARTICIPANTS 454 respondents with SCI (n=262 American Veterans and n=192 non-Veterans; N=454). INTERVENTIONS Not applicable MAIN OUTCOME MEASURES: The BPD-MS item banks. RESULTS BPD item pools were developed and refined using literature reviews, qualitative data from focus groups, and cognitive debriefing of persons with SCI and professional caregivers. The item banks then underwent expert review, reading level assessment, and translatability review prior to field testing. The items pools consisted of 180 unique questions (items). Exploratory and confirmatory factor analyses, item response theory modeling, and differential item function investigations resulted in item banks that included a total of 150 items: 75 describing the effect of autonomic dysreflexia on HRQOL, 55 describing the effect of low blood pressure (LBP) on HRQOL, and 20 describing the effect of LBP on daily activities. In addition, 10-item short forms were constructed based on item response theory-derived item information values and the clinical relevance of item content. CONCLUSIONS The new BPD-MS item banks and corresponding 10-item short forms were developed using established rigorous measurement development standards, which represents the first BPD-specific patient-reported outcomes measurement system unique for use in the SCI population.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kel G Morin
- Veterans Affairs Rehabilitation Research & Development Service (VA RR&D) Center of Excellence for Medical Consequences of SCI, James J. Peters Veterans Affairs Medical Center, Bronx, NY; Spinal Cord Damage Research Center, James J. Peters VAMC, Bronx, NY
| | - Denise C Fyffe
- Kessler Foundation, West Orange, NJ; Rutgers New Jersey Medical School, Newark, NJ
| | - Jill M Wecht
- Veterans Affairs Rehabilitation Research & Development Service (VA RR&D) Center of Excellence for Medical Consequences of SCI, James J. Peters Veterans Affairs Medical Center, Bronx, NY; Spinal Cord Damage Research Center, James J. Peters VAMC, Bronx, NY; Department of Human Performance and Rehabilitation Medicine, the Icahn School of Medicine, Mount Sinai, New York, NY; Department of Medicine, the Icahn School of Medicine, Mount Sinai, New York, NY
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15
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Carré R, Chammas M, Teissier J, Gélis A, Coulet B. Restoration of elbow extension and construction of a "key grip" in people with tetraplegia. Comparative study of a surgical plan in one or two stages. Orthop Traumatol Surg Res 2023; 109:103375. [PMID: 35907626 DOI: 10.1016/j.otsr.2022.103375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/31/2021] [Accepted: 01/07/2022] [Indexed: 02/03/2023]
Abstract
AIM We report the comparative results of functional upper extremity surgery plans in patients with tetraplegia, including restoration of elbow extension and construction of a key grip in a "one-stage" or "two-stage" operation. MATERIALS AND METHODS A series of 36 patients with tetraplegia, with a total of 45 operated upper limbs, was analyzed retrospectively with a mean follow-up of 23 months (13-39 months). We evaluated the analytical strength of elbow extension using the MRC (Medical Research Council) score, the strength of the key grip (kg/F) as well as the autonomy of the patients using functional scores; Lamb (/100) and QIF (Quadriplegia Index of Function) (/100). RESULTS Sixteen upper limbs were included in the "one-stage" group and 29 in the "two-stage" group. The groups were comparable preoperatively. Elbow extension strength was 3.6/5 in the one-stage group versus 3.7/5, p=0.74. Grip strength was 1.8kg/F in the one-stage group versus 1.3kg/F, p=0.22. Regarding the functional scores, there was no statistically significant difference between the two groups for the Lamb score (p=0.46) and the QIF (p=0.42). There was no statistically significant difference in terms of the frequency of complications for the elbow (p=0.49) and for the hand (p=0.17). The total duration of the one-stage surgery plan averaged 7.5 months compared to 24.7 months for the two-stage plan, p<0.01. The mean follow-up for the one-stage group was 21 months versus 24 months for the two-stage group. CONCLUSION The results of both plans are similar and indicate that the "one-stage" plan is a reliable option. This all-in-one surgical option reduces postoperative follow-up and dropout rates for patients during the plan timeframe. LEVEL OF EVIDENCE IV; retrospective clinical series.
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Affiliation(s)
- Rémi Carré
- CHU de Montpellier, Montpellier, France.
| | | | - Jacques Teissier
- Clinique Saint-Jean. 1, place de l'Europe, 34430 Saint-Jean-de-Védas, France
| | - Anthony Gélis
- Département de médecine physique et réadaptation de Propara, université de Montpellier, parc Euromédecine, 263, rue du Caducée, 34090 Montpellier, France
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16
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Kröger I, Wackerle H, Maier D, Mach O, Augat P. [Movement analysis in spinal cord injuries : Assistance in clinical decision making]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04409-y. [PMID: 37490136 PMCID: PMC10400683 DOI: 10.1007/s00132-023-04409-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/26/2023]
Abstract
For motor incomplete spinal cord injured patients, improvement of walking function is an important aim in the rehabilitation program. In specialized treatment centers, the 6‑minute walking test, the 10-meter walking test or the timed-up-and-go test are used as an assessment tool to determine walking ability, but these tests are not able to assess the quality of gait. Marker-based movement analysis can be used as a reliable method to evaluate the gait pattern. This allows an objective assessment of gait quality over time or can be used to support therapy planning. The benefit of such an analysis is presented by means of two case studies.
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Affiliation(s)
- Inga Kröger
- Institut für Biomechanik, Berufsgenossenschaftliche Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau, Deutschland.
- Institut für Biomechanik, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich.
| | - Hannes Wackerle
- Institut für Biomechanik, Berufsgenossenschaftliche Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau, Deutschland
- Institut für Biomechanik, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich
| | - Doris Maier
- Zentrum für Rückenmarkverletzte, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - Orpheus Mach
- Zentrum für Rückenmarkverletzte, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - Peter Augat
- Institut für Biomechanik, Berufsgenossenschaftliche Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau, Deutschland
- Institut für Biomechanik, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich
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Wecht JM, Weir JP, Katzelnick CG, Dyson-Hudson TA, Bauman WA, Kirshblum SC. Clinical trial of home blood pressure monitoring following midodrine administration in hypotensive individuals with spinal cord injury. J Spinal Cord Med 2023; 46:531-539. [PMID: 36972219 DOI: 10.1080/10790268.2021.1977904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Individuals with spinal cord injury (SCI) above thoracic level-6 (T6) experience impaired descending cortical control of the autonomic nervous system which predisposes them to blood pressure (BP) instability, including includes hypotension, orthostatic hypotension (OH), and autonomic dysreflexia (AD). However, many individuals do not report symptoms of these BP disorders, and because there are few treatment options that have been proven safe and effective for use in the SCI population, most individuals remain untreated. OBJECTIVE The primary aim of this investigation was to determine the effects of midodrine (10 mg) prescribed TID or BID in the home environment, compared to placebo, on 30-day BP, study withdrawals, and symptom reporting associated with OH and AD in hypotensive individuals with SCI. DESIGN/METHODS Participants were randomly assigned to received midodrine/placebo or placebo/midodrine, with a 2-weeks washout period in between, and both the participants and investigators were blinded to randomization order. Study medication was taken 2 or 3 times/day, depending on their sleep/wake schedule, BP, and any related symptoms were recorded before and 1 h after each dosage and periodically throughout the day. RESULTS Nineteen individuals with SCI were recruited; however, 9 withdrew prior to completion of the full protocol. A total of 1892 BP recordings (75 ± 48 recordings/participant/30-day period) were collected in the 19 participants over the two 30-day monitoring periods. Average 30-day systolic BP was significantly increased with midodrine compared to placebo (114 ± 14 vs. 96 ± 11 mmHg, respectively; P = 0.004), and midodrine significantly reduced the number of hypotensive BP recordings compared to placebo (38.7 ± 41.9 vs. 73.3 ± 40.6, respectively; P = 0.01). However, compared to placebo, midodrine increased fluctuations in BP, did not improve symptoms of OH, but did significantly worsen the intensity of symptoms associated with AD (P = 0.03). CONCLUSION Midodrine (10 mg) administered in the home environment effectively increases BP and reduces the incidence of hypotension; however these beneficial effects come at the expense of worsened BP instability and AD symptom intensity.
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Affiliation(s)
- Jill M Wecht
- James J Peters VA Medical Center, Bronx, NY, USA
- Departments of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Rehabilitation Medicine and Human Performance at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph P Weir
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS, USA
| | - Caitlyn G Katzelnick
- James J Peters VA Medical Center, Bronx, NY, USA
- Kessler Foundation, West Orange, NJ, USA
| | - Trevor A Dyson-Hudson
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - William A Bauman
- James J Peters VA Medical Center, Bronx, NY, USA
- Departments of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Rehabilitation Medicine and Human Performance at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven C Kirshblum
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
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Stilwell G, Symons D, Gooch S, Dunn J. Quantitative functional assessment of multidirectional upper limb strength for individuals in a seated position. Appl Ergon 2023; 110:104023. [PMID: 37071949 DOI: 10.1016/j.apergo.2023.104023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/27/2023] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
Understanding the limitations that are imposed by a disability is critical to ensure engineers develop designs that can be used by people with reduced function. Current literature lacks detail on this information for people with cervical spinal cord injuries. The purpose of this study was to investigate the reliability of a novel testing methodology to quantitatively assess the multi-directional upper limb strength of individuals in a seated position. Eleven non-disabled males and 10 males with a C4-C7 spinal cord injury completed isometric strength tests on parasagittal (XY) planes using a novel method. Multidirectional (XY) force measurements were taken at discrete points within the participant's reach envelope. Isometric force trends and analysis of the coefficients of variation were used to evaluate the novel methodology. The isometric force trends were consistent in showing a reduction in strength for people with higher injury levels. Analysis of the coefficient of variation showed that the methodology produces repeatable results with an average coefficient of variation of 18% and 19% for the right and left upper limbs, respectively. These results show that the novel testing methodology is a reliable way to gather quantitative multidirectional upper limb strength data for individuals in a seated position.
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Affiliation(s)
- George Stilwell
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand.
| | - Digby Symons
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Shayne Gooch
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Jennifer Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine University of Otago, Dunedin, New Zealand
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Subramanian V, Soni BM, Hughes P, Khadr R. Milk of calcium in renal calyces, renal pelvis, and ureter in a person with tetraplegia. Radiol Case Rep 2023; 18:2343-2348. [PMID: 37179812 PMCID: PMC10172631 DOI: 10.1016/j.radcr.2023.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/23/2023] [Indexed: 05/15/2023] Open
Abstract
Milk of calcium is a colloidal suspension of precipitated calcium salts which lies in a dependent manner and imaging reveals a horizontal upper edge. We report a 44-year-old male person with tetraplegia, who had been staying in bed for prolonged periods due to ischial and trochanteric pressure sores. Ultrasound scan of the kidneys revealed numerous variable-sized stones in the left kidney. CT of abdomen showed stones in the left kidney with dense layering of calcific material in a dependent distribution assuming the shape of the renal pelvis and the calyces. CT images in axial and corresponding sagittal views showed milk of calcium exhibiting a fluid level in the renal pelvis and calyces and the ureter. This is the first report of milk of calcium detected in the renal pelvis and calyces as well as in the ureter of a person with spinal cord injury. Following insertion of a ureteric stent, the milk of calcium in the ureter drained partly but the renal milk of calcium persisted. The renal stones were pulverized by ureteroscopy and LASER lithotripsy. Follow-up CT of kidneys performed 6 weeks after surgery showed the milk of calcium in the left ureter had drained, but there was no significant change of the left sizeable branching pelvi-calyceal stone regarding its extension and density.
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Affiliation(s)
- Vaidyanathan Subramanian
- Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN, United Kingdom
- Corresponding author.
| | - Bakulesh Madhusudan Soni
- Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN, United Kingdom
| | - Peter Hughes
- Department of Radiology, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN, United Kingdom
| | - Rauf Khadr
- Department of Urology, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN, United Kingdom
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Herring EZ, Graczyk EL, Memberg WD, Adams RD, Baca-Vaca GF, Hutchison BC, Krall JT, Alexander BJ, Conlan EC, Alfaro KE, Bhat PR, Ketting-Olivier AB, Haddix CA, Taylor DM, Tyler DJ, Kirsch RF, Ajiboye AB, Miller JP. Reconnecting the Hand and Arm to the Brain: Efficacy of Neural Interfaces for Sensorimotor Restoration after Tetraplegia. medRxiv 2023:2023.04.24.23288977. [PMID: 37162904 PMCID: PMC10168522 DOI: 10.1101/2023.04.24.23288977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Paralysis after spinal cord injury involves damage to pathways that connect neurons in the brain to peripheral nerves in the limbs. Re-establishing this communication using neural interfaces has the potential to bridge the gap and restore upper extremity function to people with high tetraplegia. Objective We report a novel approach for restoring upper extremity function using selective peripheral nerve stimulation controlled by intracortical microelectrode recordings from sensorimotor networks, along with restoration of tactile sensation of the hand using intracortical microstimulation. Methods A right-handed man with motor-complete C3-C4 tetraplegia was enrolled into the clinical trial. Six 64-channel intracortical microelectrode arrays were implanted into left hemisphere regions involved in upper extremity function, including primary motor and sensory cortices, inferior frontal gyrus, and anterior intraparietal area. Nine 16-channel extraneural peripheral nerve electrodes were implanted to allow targeted stimulation of right median, ulnar (2), radial, axillary, musculocutaneous, suprascapular, lateral pectoral, and long thoracic nerves, to produce selective muscle contractions on demand. Proof-of-concept studies were performed to demonstrate feasibility of a bidirectional brain-machine interface to restore function of the participant's own arm and hand. Results Multi-unit neural activity that correlated with intended motor action was successfully recorded from intracortical arrays. Microstimulation of electrodes in somatosensory cortex produced repeatable sensory percepts of individual fingers for restoration of touch sensation. Selective electrical activation of peripheral nerves produced antigravity muscle contractions. The system was well tolerated with no operative complications. Conclusion The combination of implanted cortical electrodes and nerve cuff electrodes has the potential to allow restoration of motor and sensory functions of the arm and hand after neurological injury.
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Affiliation(s)
- Eric Z Herring
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- The Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Emily L Graczyk
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
| | - William D Memberg
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
| | - Robert D Adams
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
| | | | - Brianna C Hutchison
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - John T Krall
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Benjamin J Alexander
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Emily C Conlan
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kenya E Alfaro
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Preethi R Bhat
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Chase A Haddix
- Department of Neuroscience, Lerner Research Institute, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Dawn M Taylor
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
- Department of Neuroscience, Lerner Research Institute, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Dustin J Tyler
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Robert F Kirsch
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
| | - A Bolu Ajiboye
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
| | - Jonathan P Miller
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- The Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
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21
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Stuhr M, Kowald B, Schulz AP, Meyer M, Hirschfeld S, Böthig R, Thietje R. Demographics and functional outcome of shallow water diving spinal injuries in northern Germany - A retrospective analysis of 160 consecutive cases. Injury 2023:S0020-1383(23)00198-5. [PMID: 36990902 DOI: 10.1016/j.injury.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/22/2023] [Accepted: 03/04/2023] [Indexed: 03/31/2023]
Abstract
AIM To describe demographic findings, typical injuries and functional neurological outcomes in patients with cervical trauma and tetraplegia sustained after diving into shallow water. PATIENTS AND METHODS A retrospective study was performed including all patients treated in BG Klinikum Hamburg suffering from tetraplegia after jumping into shallow water between 1st June 1980 and 31st July 2018. RESULTS One hundred and sixty patients with cervical spinal injuries and tetraplegia following a dive into shallow water were evaluated. Of these, 156 patients (97.5%) were male. The mean age was 24.3 years ± 8.1 and the accidents occurred most often in inland waters (56.2%) and mostly between May and August (90.6%). In all cases there was one vertebra fractured, whereas in 48.1% of cases, two vertebrae were severed. In the majority of cases (n = 146), a surgical procedure was performed. Overall, the mean hospital stay was 202 days (±72, range: 31-403) and one patient died. On admission, 106 patients (66.2%) showed a complete lesion according to AIS A, with incomplete lesions in the remaining 54 patients (AIS B: n = 25 [15.6%], AIS C: n = 26 [16.3%], AIS D: n = 3 [1.9%]). In two thirds of the patients, the level of paralysis on admission was at the level of segments C4 (31.9%) or C5 (33.7%). Seventeen patients (10.6%) needed prehospital resuscitation. In 55 patients (34.4%), the neurological findings improved during the course of inpatient treatment and rehabilitation. Sixty-eight patients (42.5%) developed pneumonia, of which 52 patients (76.5%) were ventilated. In addition, 56.5% of patients with paralysis levels C0-C3 required ventilation, whereas only 6.3% of patients with paralysis levels C6-C7 were affected. Three patients (1.9%) were discharged from hospital with continuous ventilation. Overall, 27.4% of all AIS A patients, 56% of all AIS B patients and 46.2% of all AIS C patients improved neurologically, with 17% of all patients being able to walk. CONCLUSIONS The consequences of a cervical spine injury after diving into shallow water are severe and lifelong. Functionally, patients may benefit from care in a specialised centre, both in the acute phase and during rehabilitation. The more incomplete the primary paralysis, the greater the possibility of neurological recovery.
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Affiliation(s)
- Markus Stuhr
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Pain Medicine, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany.
| | - Birgitt Kowald
- Zentrum für Klinische Forschung, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany
| | - Arndt P Schulz
- Zentrum für Klinische Forschung, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany; University of Luebeck, Medical Faculty, Luebeck, Germany
| | - Matthias Meyer
- University of Luebeck, Medical Faculty, Luebeck, Germany
| | - Sven Hirschfeld
- Spinal Cord Injury Center, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany
| | - Ralf Böthig
- Spinal Cord Injury Center, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany
| | - Roland Thietje
- Spinal Cord Injury Center, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany
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22
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Vieira I, Cunha P, Pinto M, Ribeiro S, Sacramento S, Silva A, Almeida C, Guedes I. Anaesthetic management of tetraplegic pregnant patients during child delivery: A systematic review. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:224-230. [PMID: 36842688 DOI: 10.1016/j.redare.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/30/2022] [Indexed: 02/28/2023]
Abstract
BACKGROUND Pregnancy in spinal cord injured patients has specific issues that must be carefully addressed. However, guidelines for their management are scarce. METHODS A systematic review of the literature regarding the anaesthetic management during delivery of pregnant patients with cervical spinal cord injury was performed on the electronic databases of PubMed (Medline) and Cochrane. RESULTS Twenty-two papers were included. A higher incidence of preterm birth and caesarean delivery were seen. Anaesthetic management was diverse, although most pregnant patients received epidural analgesia. Autonomic dysreflexia symptoms were present in 51% of pregnancies. CONCLUSION Timely management of these patients could possibly reduce caesarean and preterm delivery rates, avoid or minimize common complications, as well as reduce costs. An early reference to anaesthesiology consultation and a multidisciplinary approach is recommended.
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Affiliation(s)
- I Vieira
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
| | - P Cunha
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - M Pinto
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - S Ribeiro
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - S Sacramento
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - A Silva
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - C Almeida
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - I Guedes
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
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23
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Angerhöfer C, Vermehren M, Colucci A, Nann M, Koßmehl P, Niedeggen A, Kim WS, Chang WK, Paik NJ, Hömberg V, Soekadar SR. The Berlin Bimanual Test for Tetraplegia (BeBiTT): development, psychometric properties, and sensitivity to change in assistive hand exoskeleton application. J Neuroeng Rehabil 2023; 20:17. [PMID: 36707885 PMCID: PMC9881328 DOI: 10.1186/s12984-023-01137-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Assistive hand exoskeletons are promising tools to restore hand function after cervical spinal cord injury (SCI) but assessing their specific impact on bimanual hand and arm function is limited due to lack of reliable and valid clinical tests. Here, we introduce the Berlin Bimanual Test for Tetraplegia (BeBiTT) and demonstrate its psychometric properties and sensitivity to assistive hand exoskeleton-related improvements in bimanual task performance. METHODS Fourteen study participants with subacute cervical SCI performed the BeBiTT unassisted (baseline). Thereafter, participants repeated the BeBiTT while wearing a brain/neural hand exoskeleton (B/NHE) (intervention). Online control of the B/NHE was established via a hybrid sensorimotor rhythm-based brain-computer interface (BCI) translating electroencephalographic (EEG) and electrooculographic (EOG) signals into open/close commands. For reliability assessment, BeBiTT scores were obtained by four independent observers. Besides internal consistency analysis, construct validity was assessed by correlating baseline BeBiTT scores with the Spinal Cord Independence Measure III (SCIM III) and Quadriplegia Index of Function (QIF). Sensitivity to differences in bimanual task performance was assessed with a bootstrapped paired t-test. RESULTS The BeBiTT showed excellent interrater reliability (intraclass correlation coefficients > 0.9) and internal consistency (α = 0.91). Validity of the BeBiTT was evidenced by strong correlations between BeBiTT scores and SCIM III as well as QIF. Wearing a B/NHE (intervention) improved the BeBiTT score significantly (p < 0.05) with high effect size (d = 1.063), documenting high sensitivity to intervention-related differences in bimanual task performance. CONCLUSION The BeBiTT is a reliable and valid test for evaluating bimanual task performance in persons with tetraplegia, suitable to assess the impact of assistive hand exoskeletons on bimanual function.
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Affiliation(s)
- Cornelius Angerhöfer
- grid.6363.00000 0001 2218 4662Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Neurowissenschaftliches Forschungszentrum (NWFZ), Charité-Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany
| | - Mareike Vermehren
- grid.6363.00000 0001 2218 4662Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Neurowissenschaftliches Forschungszentrum (NWFZ), Charité-Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany
| | - Annalisa Colucci
- grid.6363.00000 0001 2218 4662Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Neurowissenschaftliches Forschungszentrum (NWFZ), Charité-Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany
| | - Marius Nann
- grid.6363.00000 0001 2218 4662Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Neurowissenschaftliches Forschungszentrum (NWFZ), Charité-Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Koßmehl
- Kliniken Beelitz GmbH, Paracelsusring 6A, Beelitz-Heilstätten, 14547 Beelitz, Germany
| | - Andreas Niedeggen
- Kliniken Beelitz GmbH, Paracelsusring 6A, Beelitz-Heilstätten, 14547 Beelitz, Germany
| | - Won-Seok Kim
- grid.412480.b0000 0004 0647 3378Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620 Seongnam-si, Republic of Korea
| | - Won Kee Chang
- grid.412480.b0000 0004 0647 3378Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620 Seongnam-si, Republic of Korea
| | - Nam-Jong Paik
- grid.412480.b0000 0004 0647 3378Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620 Seongnam-si, Republic of Korea
| | - Volker Hömberg
- SRH Gesundheitszentrum Bad Wimpfen GmbH, Bad Wimpfen, Germany
| | - Surjo R. Soekadar
- grid.6363.00000 0001 2218 4662Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Neurowissenschaftliches Forschungszentrum (NWFZ), Charité-Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany
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24
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Bell A, Grampurohit N, Kains G, Marino RJ. Developing guiding principles for technology-based rehabilitation program by engaging people with motor incomplete tetraplegia. J Neuroeng Rehabil 2022; 19:128. [PMID: 36424612 PMCID: PMC9694851 DOI: 10.1186/s12984-022-01096-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Technology-aided rehabilitation is well established in the field of neurologic rehabilitation. Despite the widespread availability, the development of technology-based interventions that incorporate perspectives of the people who will use them is lacking. OBJECTIVES This qualitative study aims to understand how people with chronic motor incomplete cervical spinal cord injury view rehabilitation technology to improve upper extremity function and neuromuscular recovery to inform future intervention development. METHODS Seven participants with chronic upper extremity impairment due to spinal cord injury/dysfunction trialed five rehabilitation technology devices. After a 30-45 min trial for each device, participants engaged in a semi-structured interview. Interviews were analyzed using a qualitative approach to explore the experience using and understand features that support motivation to use of rehabilitation technology. RESULTS Qualitative analysis revealed three major themes: (1) devices must be flexible to meet diverse needs; (2) intervention protocols must be individualized to address unique needs and contexts of users; (3) intervention protocols should be developed and updated by a skilled clinician. These themes and subthemes were used to describe guiding principles to inform future intervention design. CONCLUSION The experiences of people with cervical spinal cord injury can be elicited as part of the intervention design process to systematically develop protocols for future feasibility trials. The findings from this study can be used to inform the development of technology-aided rehabilitation programs to improve upper extremity function in people with chronic motor incomplete tetraplegia. CLINICAL TRIALS REGISTRATION NUMBER NCT04000256.
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Affiliation(s)
- Alison Bell
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, 901 Walnut Street, Suite 600, Philadelphia, PA, 19107, USA.
| | - Namrata Grampurohit
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, 901 Walnut Street, Suite 600, Philadelphia, PA, 19107, USA
| | | | - Ralph J Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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25
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Sinnott Jerram KA, Dunn JA, Smaill RP, Middleton JW. Clinical Utility of Patient-Reported Outcome Measures Used for Tendon and Nerve Transfers for Tetraplegia in New Zealand. J Hand Surg Glob Online 2022; 5:48-54. [PMID: 36704390 PMCID: PMC9870811 DOI: 10.1016/j.jhsg.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/04/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose This study determines the clinical utility of patient-reported outcome measures used to measure outcomes of upper extremity (UE) reconstructive procedures in individuals with tetraplegia. The patient-reported outcome measures are the Canadian Occupational Performance Measure, the Capabilities of Upper Extremity Questionnaire (CUE-Q), and the Personal Wellbeing Index. Methods Retrospective data of 43 individuals with spinal cord injury (SCI) levels C4-C7 tetraplegia, and American Spinal Injury Association Impairment Scale grades A-D who had upper limb reconstructive surgery were reviewed. Participants were grouped according to their SCI level and resultant surgical procedures into higher SCI severity and lower SCI severity groups. Results The mean age of participants was 26.3 years (SD 13.4; range 13-64 years). The higher-severity SCI group required elbow and hand reconstruction surgery, whereas the lower-severity group only required hand reconstruction surgery. Important differences in Canadian Occupational Performance Measure priorities were identified between the higher and lower SCI severity groups. Question redundancy was evident with the CUE-Q. The self-report Personal Wellbeing Index captures the possible impacts of improved UE function on an individual's perceived sense of personal wellbeing. Conclusions In this patient-reported outcome measure analysis, we found that the level of impairment influences patient priorities. Functional measures ought to consider UE impairment and personal wellbeing as a construct in this population, given the demands of surgery. Type of Study/Level of Evidence Prognostic II.
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Affiliation(s)
- K. Anne Sinnott Jerram
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Northern Sydney Local Health District, NSW, Australia., Australia,Burwood Academy Trust, Burwood Hospital, Christchurch, New Zealand,Corresponding author: K. Anne Sinnott Jerram, University of Sydney, John Walsh Centre for Rehabilitation Research, Kolling Institute, 10 Westbourne Street St Leonards, Sydney, NSW 2065, Australia.
| | - Jennifer Ann Dunn
- Department of Orthopedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | | | - James Walter Middleton
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Northern Sydney Local Health District, NSW, Australia., Australia,Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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26
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Mikami Y, Tinduh D, Lee K, Chotiyarnwong C, van der Scheer JW, Jung KS, Shinohara H, Narasinta I, Yoon SH, Kanjanapanang N, Sakai T, Kusumawardhani MK, Park J, Prachgosin P, Obata F, Utami DA, Laohasinnarong P, Wardhani IL, Limprasert S, Tajima F, Goosey-Tolfrey VL, Martin Ginis KA. Cultural validation and language translation of the scientific SCI exercise guidelines for use in Indonesia, Japan, Korea, and Thailand. J Spinal Cord Med 2022; 45:821-832. [PMID: 34228949 PMCID: PMC9661985 DOI: 10.1080/10790268.2021.1945857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CONTEXT Indonesia, Japan, Korea, Thailand. OBJECTIVE To culturally validate and translate the Scientific Exercise Guidelines for Adults with Spinal Cord Injury (SEG-SCI) for use in four Asian countries. DESIGN Systematic Review. PARTICIPANTS N/A. METHODS A systematic review was conducted to identify all published English- and local-language studies conducted in Indonesia, Japan, Korea, and Thailand, testing the effects of exercise training interventions on fitness and cardiometabolic health in adults with acute or chronic SCI. Protocols and results from high-quality controlled studies were compared with the SEG-SCI. Forward and backward translation processes were used to translate the guidelines into Bahasa Indonesian, Japanese, Korean and Thai languages. RESULTS Fifteen studies met the review criteria. At least one study from each country implemented exercise prescriptions that met or exceeded the SEG-SCI. Two were controlled studies. In those two studies, relative to control conditions, participants in exercise conditions achieved significant improvements in fitness or cardiometabolic health outcomes only when the exercise intervention protocol met or exceeded the SEG-SCI. During the language translation processes, end-users confirmed that SEG-SCI language and terminology were clear. CONCLUSION Clinical researchers in Indonesia, Japan, Korea and Thailand have implemented exercise protocols that meet or exceed the SCI-SEG. Results of high-quality studies align with the SEG-SCI recommendations. Based on this evidence, we recommend that the SEG-SCI be adopted in these countries. The cultural validation and translation of the SEG-SCI is an important step towards establishing consistent SCI exercise prescriptions in research, clinical and community settings around the world.
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Affiliation(s)
- Yukio Mikami
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Damayanti Tinduh
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - KunHo Lee
- Department of Prescription and Rehabilitation of Exercise, Dankook University, Cheonan, Republic of Korea
| | - Chayaporn Chotiyarnwong
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jan W. van der Scheer
- THIS Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,Peter Harrison Centre for Disability Sport, School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK
| | - Kyung Su Jung
- Medical Center for Health Promotion and Sport Science, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Shinohara
- Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan
| | - Inggar Narasinta
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Seung Hyun Yoon
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Napatpaphan Kanjanapanang
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Takafumi Sakai
- Department of Physical Therapy, Takarazuka University of Medical and Health Care, Takarazuka, Japan
| | - Martha K. Kusumawardhani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Jinho Park
- Department of Counseling, Health and Kinesiology, College of Education and Human Development, Texas A&M University-San Antonio, San Antonio, Texas, USA
| | - Pannika Prachgosin
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Futoshi Obata
- Department of Physical Therapy, Takarazuka University of Medical and Health Care, Takarazuka, Japan
| | - Ditaruni Asrina Utami
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Phairin Laohasinnarong
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Indrayuni Lukitra Wardhani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Siraprapa Limprasert
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan,Peter Harrison Centre for Disability Sport, School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK
| | - Victoria L. Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK
| | - Kathleen A. Martin Ginis
- Department of Medicine, Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, Canada,School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada,Centre for Chronic Disease Prevention and Management, Southern Medical Program, University of British Columbia, Kelowna, Canada,Correspondence to: Kathleen A. Martin Ginis. E-mail:
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27
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Abstract
CONTEXT More than half of all spinal cord injuries (SCI) occur at the cervical level leading to loss of upper limb function, restricted activity and reduced independence. Several technologies have been developed to assist with upper limb functions in the SCI population. OBJECTIVE There is no clear clinical consensus on the effectiveness of the current assistive technologies for the cervical SCI population, hence this study reviews the literature in the years between 1999 and 2019. METHODS A systematic review was performed on the state-of-the-art assistive technology that supports and improves the function of impaired upper limbs in cervical SCI populations. Combinations of terms, covering assistive technology, SCI, and upper limb, were used in the search, which resulted in a total of 1770 articles. Data extractions were performed on the selected studies which involved summarizing details on the assistive technologies, characteristics of study participants, outcome measures, and improved upper limb functions when using the device. RESULTS A total of 24 articles were found and grouped into five categories, including neuroprostheses (invasive and non-invasive), orthotic devices, hybrid systems, robots, and arm supports. Only a few selected studies comprehensively reported characteristics of the participants. There was a wide range of outcome measures and all studies reported improvements in upper limb function with the devices. CONCLUSIONS This study highlighted that assistive technologies can improve functions of the upper limbs in SCI patients. It was challenging to draw generalizable conclusions because of factors, such as heterogeneity of recruited participants, a wide range of outcome measures, and the different technologies employed.
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Affiliation(s)
- Rosti Readioff
- School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, UK,Correspondence to: Rosti Readioff, Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, LeedsLS2 9JT, UK. ; @Dr_Rosti
| | - Zaha Kamran Siddiqui
- Academic Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Caroline Stewart
- School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, UK,The Orthotic Research and Locomotor Assessment Unit (ORLAU), the Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Foundation Trust, Oswestry, UK
| | - Louisa Fulbrook
- The Orthotic Research and Locomotor Assessment Unit (ORLAU), the Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Foundation Trust, Oswestry, UK
| | - Rory J. O’Connor
- Academic Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Gee CM, Kwon BK. Significance of spinal cord perfusion pressure following spinal cord injury: A systematic scoping review. J Clin Orthop Trauma 2022; 34:102024. [PMID: 36147378 PMCID: PMC9486559 DOI: 10.1016/j.jcot.2022.102024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/27/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022] Open
Abstract
This scoping review systematically reviewed relevant research to summarize the literature addressing the significance of monitoring spinal cord perfusion pressure (SCPP) in acute traumatic spinal cord injury (SCI). The objectives of the review were to (1) examine the nature of research in the field of SCPP monitoring in SCI, (2) summarize the key research findings in the field, and (3) identify research gaps in the existing literature and future research priorities. Primary literature searches were conducted using databases (Medline and Embase) and expanded searches were conducted by reviewing the references of eligible articles and searches of Scopus, Web of Science core collection, Google Scholar, and conference abstracts. Relevant data were extracted from the studies and synthesis of findings was guided by the identification of patterns across studies to identify key themes and research gaps within the literature. Following primary and expanded searches, a total of 883 articles were screened. Seventy-three articles met the review inclusion criteria, including 34 original research articles. Other articles were categorized as conference abstracts, literature reviews, systematic reviews, letters to the editor, perspective articles, and editorials. Key themes relevant to the research question that emerged from the review included the relationship between SCPP and neurological recovery, the safety of monitoring pressures within the intrathecal space, and methods of intervention to enhance SCPP in the setting of acute traumatic SCI. Original research that aims to enhance SCPP by targeting increases in mean arterial pressure or reducing pressure in the intrathecal space is reviewed. Further discussion regarding where pressure within the intrathecal space should be measured is provided. Finally, we highlight research gaps in the literature such as determining the feasibility of invasive monitoring at smaller centers, the need for a better understanding of cerebrospinal fluid physiology following SCI, and novel pharmacological interventions to enhance SCPP in the setting of acute traumatic SCI. Ultimately, despite a growing body of literature on the significance of SCPP monitoring following SCI, there are still a number of important knowledge gaps that will require further investigation.
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Affiliation(s)
- Cameron M. Gee
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Canada
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Canada
| | - Brian K. Kwon
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Canada
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Canada
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Korik A, McCreadie K, McShane N, Du Bois N, Khodadadzadeh M, Stow J, McElligott J, Carroll Á, Coyle D. Competing at the Cybathlon championship for people with disabilities: long-term motor imagery brain-computer interface training of a cybathlete who has tetraplegia. J Neuroeng Rehabil 2022; 19:95. [PMID: 36068570 PMCID: PMC9446658 DOI: 10.1186/s12984-022-01073-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background The brain–computer interface (BCI) race at the Cybathlon championship, for people with disabilities, challenges teams (BCI researchers, developers and pilots with spinal cord injury) to control an avatar on a virtual racetrack without movement. Here we describe the training regime and results of the Ulster University BCI Team pilot who has tetraplegia and was trained to use an electroencephalography (EEG)-based BCI intermittently over 10 years, to compete in three Cybathlon events. Methods A multi-class, multiple binary classifier framework was used to decode three kinesthetically imagined movements (motor imagery of left arm, right arm, and feet), and relaxed state. Three game paradigms were used for training i.e., NeuroSensi, Triad, and Cybathlon Race: BrainDriver. An evaluation of the pilot’s performance is presented for two Cybathlon competition training periods—spanning 20 sessions over 5 weeks prior to the 2019 competition, and 25 sessions over 5 weeks in the run up to the 2020 competition. Results Having participated in BCI training in 2009 and competed in Cybathlon 2016, the experienced pilot achieved high two-class accuracy on all class pairs when training began in 2019 (decoding accuracy > 90%, resulting in efficient NeuroSensi and Triad game control). The BrainDriver performance (i.e., Cybathlon race completion time) improved significantly during the training period, leading up to the competition day, ranging from 274–156 s (255 ± 24 s to 191 ± 14 s mean ± std), over 17 days (10 sessions) in 2019, and from 230–168 s (214 ± 14 s to 181 ± 4 s), over 18 days (13 sessions) in 2020. However, on both competition occasions, towards the race date, the performance deteriorated significantly. Conclusions The training regime and framework applied were highly effective in achieving competitive race completion times. The BCI framework did not cope with significant deviation in electroencephalography (EEG) observed in the sessions occurring shortly before and during the race day. Changes in cognitive state as a result of stress, arousal level, and fatigue, associated with the competition challenge and performance pressure, were likely contributing factors to the non-stationary effects that resulted in the BCI and pilot achieving suboptimal performance on race day. Trial registration not registered Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01073-9.
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Affiliation(s)
- Attila Korik
- Intelligent Systems Research Centre, Ulster University, Derry, UK.
| | - Karl McCreadie
- Intelligent Systems Research Centre, Ulster University, Derry, UK
| | - Niall McShane
- Intelligent Systems Research Centre, Ulster University, Derry, UK
| | - Naomi Du Bois
- Intelligent Systems Research Centre, Ulster University, Derry, UK
| | | | - Jacqui Stow
- National Rehabilitation Hospital of Ireland, Dun Laoghaire, Ireland
| | | | - Áine Carroll
- National Rehabilitation Hospital of Ireland, Dun Laoghaire, Ireland.,University College Dublin, Dublin, Ireland
| | - Damien Coyle
- Intelligent Systems Research Centre, Ulster University, Derry, UK
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Kouwijzer I, van der Meer M, Janssen TWJ. Effects of trunk muscle activation on trunk stability, arm power, blood pressure and performance in wheelchair rugby players with a spinal cord injury. J Spinal Cord Med 2022; 45:605-13. [PMID: 33166206 DOI: 10.1080/10790268.2020.1830249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: In wheelchair rugby (WR) athletes with tetraplegia, wheelchair performance may be impaired due to (partial) loss of innervation of upper extremity and trunk muscles, and low blood pressure (BP). The objective was to assess the effects of electrical stimulation (ES)-induced co-contraction of trunk muscles on trunk stability, arm force/power, BP, and WR performance.Design: Cross-sectional study.Setting: Rehabilitation research laboratory and WR court.Participants: Eleven WR athletes with tetraplegia.Interventions: ES was applied to the rectus abdominis, obliquus externus abdominis and erector spinae muscles. For every test, the ES condition was compared to the non-ES condition.Outcome measures: Stability was assessed with reaching tasks, arm force/power with an isokinetic test on a dynamometer, BP during an ES protocol and WR skill performance with the USA Wheelchair Rugby Skill Assessment.Results: Overall reaching distance (ES 14.6 ± 7.5 cm, non-ES 13.4 ± 8.2 cm), and BP showed a significant increase with ES. Arm force (ES 154 ± 106 N, non-ES 148 ± 102 N) and power (ES 37 ± 26 W, non-ES 36 ± 25 W), and WR skills were not significantly improved.Conclusion: ES-induced trunk muscle activation positively affects trunk stability and BP, but not arm force/power. No effects were found in WR skill performance, probably due to abdominal strapping. More research is needed to assess different ES (training) protocols and longitudinal effects.
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Cardoso LRL, Bochkezanian V, Forner-Cordero A, Melendez-Calderon A, Bo APL. Soft robotics and functional electrical stimulation advances for restoring hand function in people with SCI: a narrative review, clinical guidelines and future directions. J Neuroeng Rehabil 2022; 19:66. [PMID: 35773733 PMCID: PMC9245887 DOI: 10.1186/s12984-022-01043-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Recovery of hand function is crucial for the independence of people with spinal cord injury (SCI). Wearable devices based on soft robotics (SR) or functional electrical stimulation (FES) have been employed to assist the recovery of hand function both during activities of daily living (ADLs) and during therapy. However, the implementation of these wearable devices has not been compiled in a review focusing on the functional outcomes they can activate/elicit/stimulate/potentiate. This narrative review aims at providing a guide both for engineers to help in the development of new technologies and for clinicians to serve as clinical guidelines based on the available technology in order to assist and/or recover hand function in people with SCI. Methods A literature search was performed in Scopus, Pubmed and IEEE Xplore for articles involving SR devices or FES systems designed for hand therapy or assistance, published since 2010. Only studies that reported functional outcomes from individuals with SCI were selected. The final collections of both groups (SR and FES) were analysed based on the technical aspects and reported functional outcomes. Results A total of 37 out of 1101 articles were selected, 12 regarding SR and 25 involving FES devices. Most studies were limited to research prototypes, designed either for assistance or therapy. From an engineering perspective, technological improvements for home-based use such as portability, donning/doffing and the time spent with calibration were identified. From the clinician point of view, the most suitable technical features (e.g., user intent detection) and assessment tools should be determined according to the particular patient condition. A wide range of functional assessment tests were adopted, moreover, most studies used non-standardized tests. Conclusion SR and FES wearable devices are promising technologies to support hand function recovery in subjects with SCI. Technical improvements in aspects such as the user intent detection, portability or calibration as well as consistent assessment of functional outcomes were the main identified limitations. These limitations seem to be be preventing the translation into clinical practice of these technological devices created in the laboratory.
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Affiliation(s)
- Lucas R L Cardoso
- Biomedical Engineering, School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.
| | - Vanesa Bochkezanian
- College of Health Sciences, School of Health, Medical and Applied Sciences, Central Queensland University, North Rockhampton, Australia
| | - Arturo Forner-Cordero
- Biomechatronics Laboratory, Escola Politecnica, University of São Paulo, São Paulo, Brazil
| | - Alejandro Melendez-Calderon
- Biomedical Engineering, School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Antonio P L Bo
- Biomedical Engineering, School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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Wang W, Tong A, Liu N, Biering-Soerensen F, Tong S. Case series on the Charcot neuroarthropathy in hands after cervical central cord syndrome. BMC Musculoskelet Disord 2022; 23:545. [PMID: 35668418 DOI: 10.1186/s12891-022-05502-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 06/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Charcot neuroarthropathy (CNA) of the upper extremity occurs most frequently in shoulders. However, CNA in the hands is uncommon and seldom be reported. The onset of CNA is usually insidious. If this process continues undetected, it can result in joint deformity, ulceration and/or superinfection, loss of function, and amputation or even death. In this article, we are going to present three cases of CNA in the hands of individuals with cervical spinal cord injury (SCI) with central cord syndrome. Case presentation Three male individuals with cervical spinal stenosis contracted tetraplegia (American Spinal Injury Association Impairment Scale Grade D, D, and B) due to spinal cord contusion after a trauma and developed hand swelling without pain 2 to 3 months after their SCI. X-ray showed degenerative joint changes in the hands. CNA was considered due to the patient’s history of cervical SCI, loss of motor function and sensation, symptoms of painless swelling, physical examination, and X-ray findings. The self-care sub scores of Spinal Cord Independence Measure III improved slightly only during rehabilitation and follow-up due to poor hand function. Conclusions CNA may develop after a central or peripheral neurological disorder. Nearly every joint of the body can be affected and the lower limbs are the most frequently involved. However, CNA of the hand is rare. We present three patients with CNA in the hands after cervical SCI and review the features and early differential diagnosis of CNA. Currently there is no specific treatment available. Therefore, early identification of CNA and adequate protection to the affected joints seem important.
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Abstract
OBJECTIVE To compare the safety and effectiveness of wire (WE) vs. disc (DE) electrodes to restore cough in subjects with spinal cord injury (SCI). DESIGN Clinical trials assessing the effectiveness and clinical outcomes associated with two electrode systems to activate the expiratory muscles. SETTING Inpatient hospital setting for DE or WE electrode insertion; outpatient evaluation of cough efficacy and instructions for home use. PARTICIPANTS Twenty-nine subjects with SCI; 17 participants with DE and 12 with WE implants. INTERVENTION Surgical implantation of WE or DE to restore cough. Daily application of spinal cord stimulation (SCS) at home. MAIN OUTCOME MEASURE(S) Airway pressure (P) and peak airflow (F) generation achieved with SCS; clinical parameters including ease in raising secretions, incidence of acute respiratory tract infections (RTI) and side effects. RESULTS P and F achieved with DE and WE were not significantly different. For example, at total lung capacity (TLC) with participant effort, P was 128 ± 12 cmH2O and 118 ± 14 cmH2O, with DE and WE, respectively. The degree of difficulty in raising secretions improved markedly in both groups. The incidence of RTI per year fell from 1.3 ± 0.3 and 1.3 ± 0.5-0.3 ± 0.1 and 0.1 ± 0.1 for DE and WE groups, respectively (P < 0.01 for both when compared to pre-implant values and NS between DE and WE groups). The only significant side effect i.e. short-term autonomic dysreflexia was also similar between groups. CONCLUSIONS The results of this investigation indicate that both DE and WE result in comparable degrees of expiratory muscle activation, clinical benefits and side effects. Importantly, SCS to restore cough can be achieved with use of WE which can be placed using minimally invasive techniques and associated reduction in cost, surgical time and overall risk.Trial registration: ClinicalTrials.gov identifier: NCT00116337., NCT01659541, FDA IDE: G980267.
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Affiliation(s)
- Anthony F. DiMarco
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
- Department of Research, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Robert T. Geertman
- Department of Neurosurgery, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Gregory A. Nemunaitis
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
- Cleveland Clinic, Cleveland, Ohio, USA
| | - Krzysztof E. Kowalski
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
- Department of Research, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
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Chigblo P, Lawson E, Layes T, Alihonou T, Padonou A, Amossou F, Goukodadja O, Gbedinhessi C, Madougou S, Akue AHM. [Epidemiology of cervical spine injuries in National teaching hospital Hubert K. Maga of Cotonou]. Mali Med 2022; 37:6-10. [PMID: 38506218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Trauma to the cervical spine is a real public health problem. They can cause neurological complications that are sometimes irreversible and mortality remains high. The causes are dominated by traffic and work accidents. We assess their epidemiological and lesional aspects in our work environment. MATERIAL AND METHOD This was a descriptive retrospective study of any cervical spine trauma patient admitted to the National teaching hospital Hubert Koutoukou Maga of Cotonou between January 2010 and June 2014 for which the clinical file was complete. RESULTS 57 files were retained. The average age was 38.7 years (19 - 71 years). The predominance was male with a sex ratio of 4.2. The mean admission time was 27.5 days (3 hours - 175 days). As aetiologies, we found: traffic accidents (41 cases or 71.9%), work accidents (13 cases or 22.9%) and domestic accidents (3 cases or 5.3%). From an anatomopathological point of view, there were 16 simple fractures, one compression fracture, 13 dislocation fractures, 15 pure dislocations, 5 sprains, 2 post-traumatic disc herniations and 5 decompensations of cervicarthrosis myelopathy. The lesions involved the upper cervical spine (7%), the lower cervical spine (71.9%), the upper and lower cervical spine (21.1%). Thirty-two patients (56.1%) were quadriplegic and autonomic disorders were present in 7 patients (12.3%). CONCLUSION Cervical spine trauma is frequent in Cotonou. They are often of interest to the young male subject. The lesions predominate on the lower cervical spine.
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Affiliation(s)
- Pascal Chigblo
- Clinique Universitaire de Traumatologie Orthopédie et de Chirurgie Réparatrice, CNHU-HKM Cotonou, Bénin
| | - Eric Lawson
- Clinique Universitaire de Traumatologie Orthopédie et de Chirurgie Réparatrice, CNHU-HKM Cotonou, Bénin
| | - Toure Layes
- Clinique Universitaire de Traumatologie Orthopédie et de Chirurgie Réparatrice, CNHU-HKM Cotonou, Bénin
| | - Thierry Alihonou
- Service de Chirurgie, Centre Hospitalier Universitaire Départemental O-P, Porto-Novo, Bénin
| | - Adébola Padonou
- Clinique Universitaire de Traumatologie Orthopédie et de Chirurgie Réparatrice, CNHU-HKM Cotonou, Bénin
| | - Francois Amossou
- Service de Chirurgie, Centre Hospitalier Universitaire Départemental O-P, Porto-Novo, Bénin
| | - Oswald Goukodadja
- Clinique Universitaire de Traumatologie Orthopédie et de Chirurgie Réparatrice, CNHU-HKM Cotonou, Bénin
| | - Christian Gbedinhessi
- Clinique Universitaire de Traumatologie Orthopédie et de Chirurgie Réparatrice, CNHU-HKM Cotonou, Bénin
| | - Soumaïla Madougou
- Clinique Universitaire de Traumatologie Orthopédie et de Chirurgie Réparatrice, CNHU-HKM Cotonou, Bénin
| | - Aristote Hans-Moevi Akue
- Clinique Universitaire de Traumatologie Orthopédie et de Chirurgie Réparatrice, CNHU-HKM Cotonou, Bénin
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Bersch I, Fridén J. Electrical stimulation alters muscle morphological properties in denervated upper limb muscles. EBioMedicine 2021; 74:103737. [PMID: 34896792 DOI: 10.1016/j.ebiom.2021.103737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/22/2022] Open
Abstract
Background Damage to lower motor neuron causes denervation and degeneration of the muscles affected. Experimental and clinical studies of muscle denervation in lower extremities demonstrated that direct electrical stimulation (ES) of muscle can prevent denervation atrophy and restore contractility. The aim of this study was to identify possible myogenic effect of ES on denervated forearm and hand muscles in persons with spinal cord injury (SCI) and tetraplegia. Methods This prospective interventional study with repeated measurement design included 22 patients aged 48·6 (± 15·7), 0·25 (0·1/46) years after spinal cord lesion, AIS A-D. In each patient, two electrophysiologically-confirmed denervated muscles in the hand and forearm were analyzed – one extrinsic (Extensor Carpi Ulnaris - ECU) and one intrinsic (1st Dorsal Interosseus - IOD1). Muscles were stimulated for 33 min, five times per week over a 12-weeks period. Using ultrasonography (USG), muscle thickness (MT) and pennation angle (PA) of these muscles were determined at start and end of the stimulation period. Findings MT of IOD1 increased from 6·3 mm (± 3·2 mm) to 9·2 mm (± 2·4 mm) (p = 0·004) and the PA from 5·5° (± 3·0°) to 11° (± 2·2°) (p = 0·001). The corresponding values for the ECU were 5·5 mm (± 2·5 mm) to 7·0 mm (± 2·2 mm) (p = 0·039) and 5·5° (± 3·4°) to 9·4° (± 3·8°) (p = 0·005), respectively. The correlation of MT between baseline and completion was r = 0·58 (p = 0·037) for the ECU and r = 0·63 (p = 0·008) for the IOD1. Interpretation 12 weeks of direct muscle stimulation increases the MT and PA of the denervated intrinsic and extrinsic hand muscles studied. Funding Swiss Paraplegic Centre, Switzerland
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Wang R, Zhu J, Zhang J, Ma Y, Jiang H. Psychological assessments of a senile patient with tetraplegia who received brain-computer interface implantation: a case report. Neurol Sci 2021; 43:1427-1430. [PMID: 34812967 DOI: 10.1007/s10072-021-05393-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 06/07/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Research on individuals with brain-computer interface (BCI) presents not only technological challenges but ethical challenges (e.g., psychological aspects) as well. We assessed the mental health of a senile patient with tetraplegia after an invasive implantation of BCI and a long-term daily training, in order to provide new experience about the ethical impact of BCI on users and inform future clinical applications of such devices. METHODS This case was a 71-year-old man with tetraplegia for 2 years. Prior to the implant surgery of BCI, and 1 month, 2 months, 3 months, and 9 months after training, a series of tests for cognition, emotion, social support, sleep, and quality of life were performed to evaluate the patient's mental health. RESULTS Compared with baseline before surgery, the patients' cognition, emotion, social support, sleep, and quality of life improved after the surgery and the long-term daily training. At 3 months post-training, the patient's cognitive score measured by Mini-mental State Examination reached the cutoff point for cognitive impairment in the elderly. Subjective well-being and quality of life showed a slight decline at 9 months post-training compared with that 3 months post-training but remained above the baseline. CONCLUSION This study shows the psychological benefits in a senile patient after an invasive BCI implantation and a long-term daily training. BCI ethics is still in its early stages, and further research is needed to understand emerging psychological states of this specific population.
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Affiliation(s)
- Rui Wang
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Junming Zhu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Jianmin Zhang
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
| | - Ying Ma
- Department of Psychiatry, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
| | - Hongjie Jiang
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
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Bazarek S, Sten M, Nin D, Brown JM. Supinator to Posterior Interosseous Nerve Transfer for Restoration of Finger Extension. Oper Neurosurg (Hagerstown) 2021; 21:E408-E413. [PMID: 34392370 DOI: 10.1093/ons/opab263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cervical spinal cord injuries result in a severe loss of function and independence. The primary goal for these patients is the restoration of hand function. Nerve transfers have recently become a powerful intervention to restore the ability to grasp and release objects. The supinator muscle, although a suboptimal tendon transfer donor, serves as an ideal distal nerve donor for reconstructive strategies of the hand. This transfer is also applicable to lower brachial plexus injuries. OBJECTIVE To describe the supinator to posterior interosseous nerve transfer with the goal of restoring finger extension following spinal cord or lower brachial plexus injury. METHODS Nerve branches to the supinator muscle are transferred to the posterior interosseous nerve supplying the finger extensor muscles in the forearm. RESULTS The supinator to posterior interosseous nerve transfer is effective in restoring finger extension following spinal cord or lower brachial plexus injury. CONCLUSION This procedure represents an optimal nerve transfer as the donor nerve is adjacent to the target nerve and its associated muscles. The supinator muscle is innervated by the C5-6 nerve roots and is often available in cases of cervical SCI and injuries of the lower brachial plexus. Additionally, supination function is retained by supination action of the biceps muscle.
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Affiliation(s)
- Stanley Bazarek
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret Sten
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Darren Nin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin M Brown
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Figoni SF, Dolbow DR, Crawford EC, White ML, Pattanaik S. Does aerobic exercise benefit persons with tetraplegia from spinal cord injury? A systematic review. J Spinal Cord Med 2021; 44:690-703. [PMID: 32043944 PMCID: PMC8477928 DOI: 10.1080/10790268.2020.1722935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
CONTEXT This review synthesizes the findings of previous research studies on the cardiovascular and metabolic benefits of aerobic exercise for individuals with tetraplegia secondary to spinal cord injury. They are often less active due to muscular paralysis, sensory loss, and sympathetic nervous system dysfunction that result from injury. Consequently, these persons are at higher risk for exercise intolerance and secondary health conditions. OBJECTIVE To evaluate the evidence concerning efficacy of aerobic exercise training for improving health and exercise performance in persons with tetraplegia from cervical injury. METHODS The search engines PubMed and Google Scholar were used to locate published research. The final 75 papers were selected on the basis of inclusion criteria. The studies were then rank-ordered using Physiotherapy Evidence Database. RESULTS Studies combining individuals with tetraplegia and paraplegia show that voluntary arm-crank training can increase mean peak power output by 33%. Functional electrical stimulation leg cycling was shown to induce higher peak cardiac output and stroke volume than arm-crank exercise. A range of peak oxygen uptake (VO2peak) values have been reported (0.57-1.32 L/min). Both VO2peak and cardiac output may be enhanced via increased muscle pump in the legs and venous return to the heart. Hybrid exercise (arm-crank and functional electrical stimulation leg cycling) can result in greater peak oxygen uptake and cardiovascular responses. CONCLUSION Evidence gathered from this systematic review of literature is inconclusive due to the lack of research focusing on those with tetraplegia. Higher power studies (level 1-3) are needed with the focus on those with tetraplegia.
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Affiliation(s)
- Stephen F Figoni
- Spinal Cord Injury/Disorders Healthcare Group (128), Tibor Rubin VA Medical Center, Long Beach, California, USA
| | - David R Dolbow
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Edwin C Crawford
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Margaret L White
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Sambit Pattanaik
- College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA
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Nakaoka S, Kondo H, Matsuoka K, Shibuya T, Otomo T, Hamada Y, Sakamoto K, Ozono K, Sakai N. Mucolipidosis Ⅱ and III with neurological symptoms due to spinal cord compression. Brain Dev 2021; 43:867-872. [PMID: 33965289 DOI: 10.1016/j.braindev.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
In mucopolysaccharidoses (MPS), spinal cord compression (SCC) resulting from glycosaminoglycan (GAG) accumulation is a critical complication that can cause significant neurological and respiratory morbidities. However, clinically similar disorders such as mucolipidosis types II and III (ML) with SCC have been scarcely reported. Herein, we report four patients with ML who had SCC. Brain MRI revealed progressive spinal canal stenosis and SCC. In addition, T2-weighted high signal changes in the cervical cord were detected in two cases. Severe cases of SCC were detected as early as 1 year of age. All cases had respiratory problems. One case showed severe hypoxia and another, severe sleep apnea. In two cases, respiratory insufficiency and tetraplegia rapidly progressed as SCC progressed. Then, the patients became bedridden and needed artificial ventilation. In addition, two of the four patients died of respiratory failure. The autopsy of one patient revealed a compressed cervical cord and marked dura mater thickening due to GAG accumulation. These findings suggest that the accumulation of substrates in the dura mater caused SCC in the patients with ML. Our cases indicate that SCC is expected to be a common and critical complication of ML and MPS. MRI evaluation of cervical involvements and careful clinical observation are required in patients with ML.
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Affiliation(s)
- Sachiko Nakaoka
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Department of Pediatrics, Faculty of Medicine, University of Toyama, Japan
| | - Hidehito Kondo
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Department of Pediatrics and Neonatology, Japanese Red Cross Kyoto Daiichi Hospital, Japan.
| | - Keiko Matsuoka
- Department of Pathology, Osaka Women's and Children's Hospital, Japan
| | - Toko Shibuya
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan
| | - Takanobu Otomo
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Department of Molecular and Genetic Medicine, Kawasaki Medical School, Japan
| | - Yusuke Hamada
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Department of Pediatrics, Toyonaka Municipal Hospital, Japan
| | - Kenichi Sakamoto
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan
| | - Norio Sakai
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Child Healthcare and Genetic Science Laboratory, Division of Health Sciences, Osaka University Graduate School of Medicine, Japan
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Coulet B, Chammas M. Palsy of elbow extension. Hand Surg Rehabil 2021; 41S:S83-S89. [PMID: 34428569 DOI: 10.1016/j.hansur.2020.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 10/20/2022]
Abstract
Elbow extension palsy is generally well tolerated, because when standing up, it is alleviated by gravity. In the case of trunk paralysis or brachial plexus palsy, standing is possible, thus the restoration of active elbow extension improves the hand's positioning above the shoulder, and allows the elbow to be locked in extension, which is necessary during certain activities such as cycling. In these palsy cases, the triceps brachii will be reinnervated by nerve transfers if surgery is performed early enough before irreversible atrophy of the effector muscle sets in. In these situations, secondary tendon transfers are rarely indicated. Few available muscles can be harvested without deleterious consequences on the donor site. Finally, in patients with a very deficient upper limb but with a healthy contralateral limb, when nerve transfers are no longer possible, elbow extension will not be restored. In the tetraplegics using a wheelchair, elbow extension becomes essential for positioning the hand in space and for potentiating the transferable muscles to activate the hand. As nerve transfers have rare indications and are currently being validated in this population, palliative tendon transfers are the reference technique. They must be integrated into an overall upper limb reconstructive surgery program that takes into consideration the potentially usable muscles and the presence of elbow flexion contracture and supination deformity of the forearm. Elbow extension restoration techniques are based on the transfer of two muscles, the posterior deltoid and the biceps brachii. The first is very effective and has very specific requirements, notably good anterior stabilization of the shoulder by the pectoralis major, while the second has broader indications, notably in the case of elbow contracture and inability to stabilize the shoulder anteriorly.
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Affiliation(s)
- B Coulet
- Faculté de Médecine, Université Montpellier 1, 5, Boulevard Henri IV, 34090 Montpellier, France; Service de chirurgie de la main et du membre supérieur, chirurgie des paralysies, Institut de Neuro-Orthopédie Montpellier, Hôpital Lapeyronie, CHU de Montpellier, Avenue du doyen Gaston Giraud, 34295 Montpellier Cedex 5, France.
| | - M Chammas
- Faculté de Médecine, Université Montpellier 1, 5, Boulevard Henri IV, 34090 Montpellier, France; Service de chirurgie de la main et du membre supérieur, chirurgie des paralysies, Institut de Neuro-Orthopédie Montpellier, Hôpital Lapeyronie, CHU de Montpellier, Avenue du doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
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Leclercq C, Hentz VR. Surgical restoration of the upper limb in cervical spinal cord injury patients. Hand Surg Rehabil 2021; 41S:S148-S152. [PMID: 34391954 DOI: 10.1016/j.hansur.2020.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 05/04/2020] [Accepted: 05/16/2020] [Indexed: 10/20/2022]
Abstract
Prior to the 1950s, relatively few patients who suffered a transection of the cervical spinal cord survived their injury. Improved medical care and better coordination have resulted in greater numbers of patients surviving and leaving the hospital. The pioneering work of individual surgeons during the 1960s and 1970s stimulated interest in surgical restoration of upper limb function in tetraplegic patients. Since the publication of Moberg's monograph in 1978, surgical improvement of the upper limbs is regarded as one of the options that should be offered to tetraplegic individuals to improve their function. Patients are classified according to the level of spinal cord injury and the residual motor function (international classification: groups 1 to 9). Surgical procedures are adapted to the motor level for each group of patients. Indications for these procedures are well standardized, the techniques are well mastered, and predictable results can be expected. New nerve transfer techniques have been developed in recent years; they are currently being evaluated.
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Affiliation(s)
- C Leclercq
- Institut de la Main, 22, rue Georges Bizet, 75116 Paris, France.
| | - V R Hentz
- Department of Plastic Surgery, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA.
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Moiziard V, Lansaman T, Mauruc Soubirac E, Revol M, Coulet B, Hugeron C, Gelis A, Laffont I. Assessment of the upper limb of the tetraplegic patient. Hand Surg Rehabil 2021; 41S:S137-S147. [PMID: 34265478 DOI: 10.1016/j.hansur.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/15/2018] [Accepted: 02/01/2019] [Indexed: 11/16/2022]
Abstract
The aim of our study is to describe the assessment of the upper limb in tetraplegic patients to follow his (her) neurological progression and to define the medical or surgical treatment program. We selected upper limb assessment tools and scales for tetraplegic patients described in the medical literature through a PubMed search over the last four decades. For each method, we present the implementation rules and its metrological properties, including its validity in French. We selected five clinical scales for functional evaluation of grasping, as well as four scales for evaluating the overall function of these patients. Finally, we identified three complementary precision assessment tools. The AIS (ASIA Impairment Scale) classification describes the level and the severity of the spinal cord lesion. The Giens classification is more practical for describing the upper limb in middle and low tetraplegia. Impairments can be assessed with most common generic scales and nonspecific measurement devices: range of motion, strength, sensory loss, spasticity, joint pain. Measurement of pinch and grip strength is widely used and easy to perform. The Capabilities of Upper Extremity (CUE) and the Jebsen Taylor Test are the best validated and usable scales. At a general functional level, the Spinal Cord Independence Measure (SCIM) is the most relevant scale in these patients. Motor nerve blocks, electromyography, movement analysis and echography are promising additional methods. Assessment of the upper limb of tetraplegic patients relies both on generic and specific assessment tools and scales.
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Affiliation(s)
- V Moiziard
- Université de Montpellier, Département de MPR CHU de Montpellier, Euromov Digital Health in Motion, Montpellier, France
| | - T Lansaman
- Service de MPR, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380 Garches, France
| | - E Mauruc Soubirac
- Service de MPR, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380 Garches, France
| | - M Revol
- Service de Chirurgie Plastique, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - B Coulet
- Université de Montpellier, Département de Chirurgie orthopédique, CHU de Montpellier, Euromov Digital Health in Motion, Montpellier, France
| | - C Hugeron
- Service de MPR, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380 Garches, France
| | - A Gelis
- Université de Montpellier, Centre Propara, Montpellier, France
| | - I Laffont
- Université de Montpellier, Département de MPR CHU de Montpellier, Euromov Digital Health in Motion, Montpellier, France.
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Aguirre-Güemez AV, Mendoza-Muñoz M, Jiménez-Coello G, Rhoades-Torres GM, Pérez-Zavala R, Barrera-Ortíz A, Quinzaños-Fresnedo J. Nerve transfer rehabilitation in tetraplegia: Comprehensive assessment and treatment program to improve upper extremity function before and after nerve transfer surgery, a case report. J Spinal Cord Med 2021; 44:621-626. [PMID: 31525150 PMCID: PMC8288124 DOI: 10.1080/10790268.2019.1660841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
CONTEXT A 28-year-old male, sustained a traumatic Spinal Cord Injury (SCI) in January 2015, and was classified as AIS A, neurological level of injury (NLI) C4. As an inpatient at the SCI rehabilitation unit, he underwent multidisciplinary assessment involving SCI specialists, peripheral nerve surgeons, psychologists, occupational and physical therapists. Team consensus determined he was a candidate for nerve transfer surgery to improve upper extremity function. The patient undertook a pre-surgical neurorehabilitation program of 3 months duration. Surgery was performed bilaterally at 11 and 13 months after SCI (right and left arm respectively). FINDINGS Upon completion of surgical procedures, the patient underwent an intensive post-surgical rehabilitation program based on established goals, with follow-up every 3 months, up to 24 months after the surgery. Notable improvements were wheelchair propulsion, the ability to relieve pressure, grasp, pinch, and release an object. Standardized measures for SCI individuals (SCIM-III, CUE-Q, LiSAT-9 and UEMS) showed significant improvements. CLINICAL RELEVANCE Nerve transfers in tetraplegia are an underused technique. The benefits of surgery along with an intensive neurorehabilitation program, can improve independence and function in daily living activities for a properly selected group of individuals.
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Affiliation(s)
| | - Mario Mendoza-Muñoz
- Servicio de Cirugía de la Mano y Microcirugía, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Gabriela Jiménez-Coello
- Médicos residentes de la especialidad de Medicina de Rehabilitación Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Gerald Martín Rhoades-Torres
- Médicos residentes de la especialidad de Medicina de Rehabilitación Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Ramiro Pérez-Zavala
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Aida Barrera-Ortíz
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Jimena Quinzaños-Fresnedo
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Mexico City, Mexico,Correspondence to: Jimena Quinzaños-Fresnedo, División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Avenida México-Xochimilco No. 289, Col. Arenal de Guadalupe, CP 14389, Delegación Tlalpan, México D.F.; Ph: 52(55)59991000, ext. 13410.
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Bandini A, Kalsi-Ryan S, Craven BC, Zariffa J, Hitzig SL. Perspectives and recommendations of individuals with tetraplegia regarding wearable cameras for monitoring hand function at home: Insights from a community-based study. J Spinal Cord Med 2021; 44:S173-S184. [PMID: 33960874 PMCID: PMC8604485 DOI: 10.1080/10790268.2021.1920787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Wearable cameras have great potential for producing novel outcome measures of upper limb (UL) function and guiding care in individuals with cervical spinal cord injury (cSCI) living in the community. However, little is known about the perspectives of individuals with cSCI on the potential adoption of this technology. OBJECTIVE To analyze feedback from individuals with cSCI regarding the use of wearable cameras to record daily activities at home, in order to define guidelines for improving the design of this technology and fostering its implementation to optimize UL rehabilitation. DESIGN Mixed-methods study. PARTICIPANTS Thirteen adults with cSCI C3-C8 AIS A-D impairment. MEASURES Interview including survey and semi-structured questions. RESULTS Participants felt that this technology can provide naturalistic information regarding hand use to clinicians and researchers, which in turn can lead to better assessments of UL function and optimized therapies. Participants described the technology as easy-to-use but often reported discomfort that prevented them from conducting long recordings of fully natural activities. Privacy concerns included the possibility to capture household members and personal information displayed on objects (e.g. smartphones). CONCLUSION We provide the first set of guidelines to help researchers and therapists understand which steps need to be taken to translate wearable cameras into outpatient care and community-based research for UL rehabilitation. These guidelines include miniaturized and easy-to-wear cameras, as well as multiple measures for preventing privacy concerns such as avoiding public spaces and providing control over the recordings (e.g. start and stop the recordings at any time, keep or delete a recording).
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Affiliation(s)
- Andrea Bandini
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, Canada
| | - Sukhvinder Kalsi-Ryan
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - José Zariffa
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Abstract
Background Nerve transfer to improve upper extremity function in persons with cervical spinal cord injury (SCI) is a new reconstructive option, and has led to more people seeking and sharing surgical information and experiences. This study evaluated the role of social media in information-sharing on nerve transfer surgery within the SCI community. Methods Data were collected from Facebook, which is the favored information-sharing platform among individuals seeking medical information. Searched terms included ‘spinal cord injury’ and ‘SCI’ and excluded groups with: less than two members (n = 7); closed groups (n = 2); not pertaining to SCI (n = 13); restricted access (n = 36); and non-English (n = 2). Within public and private accessed groups, searches were conducted for ‘nerve’, ‘transfer’, ‘nerve transfer’, and ‘nerve surgery’. Each post about nerve transfer, responses to posts, and comments about nerve transfer in response to unrelated posts were tabulated. Thematic content analyses were performed and data were categorized as seeking information, sharing information, sharing support, and sharing appreciation. Results The search yielded 99 groups; 35 met the inclusion criteria (average size = 2007, largest = 12,277). Nerve transfer was discussed in nine groups, with 577 total mentions. In the seeking information axis, posts were related to personal experience (54%), objective information (31%), surgeon/center performing the procedure (9%), and second opinion (4%). At least 13% of posts were from individuals learning about nerve transfers for the first time. In the sharing information axis, the posts: shared personal experience (52%); shared objective information (13%); described alternative treatment (3%); tagged someone to share information (11%); linked to outside resources (12%); and recommended a specific surgeon/center (9%). Conclusion Social media is an important source of information and support for people with SCI. There is a paucity of information on nerve transfers. These study findings will inform implementation of future education strategies.
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Affiliation(s)
- Syena Moltaji
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Christine B Novak
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jana Dengler
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Division of Plastic and Reconstructive Surgery, Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Lien WC, Wang WM, Wang JD, Wang F. The association between economic indicators and the incidence of tetraplegia from traumatic spinal cord injury in Taiwan. BMC Neurol 2021; 21:117. [PMID: 33731028 PMCID: PMC7968275 DOI: 10.1186/s12883-021-02141-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Economic performance may affect public health parameters. This study aimed to determine the time trend of incidence of traumatic spinal cord injury (SCI) and its association with income, presented by GDP (gross domestic product) per capita. Methods This study was a retrospective observational study in Taiwan. Newly diagnosed SCI patients with moderate to severe disability from 2002 to 2015 were identified from the reimbursement database of the National Health Insurance (NHI) system (1998–2015). CIR16–99 (cumulative incidence rate, aged 16–99 years, per 103 person-years) and CIR16–59 (aged 16–59 years) of SCI from 2002 to 2015 were measured. Results There were 5048 newly diagnosed SCI patients during the study period. After controlling the factors of sex, urbanization level, literacy, income inequality, and global financial crisis (mixed effects models), the CIR16–99 of SCI, traumatic SCI, motor vehicle (MV)-related SCI, fall-related SCI, tetraplegia, traumatic tetraplegia, MV-related tetraplegia, and fall-related tetraplegia were inversely associated with GDP per capita; the β coefficients ranged from − 4.85 (95% confidence interval − 7.09 to − 2.6) for total SCI to − 0.8 (− 1.3 to − 0.29) for fall-related tetraplegia. We restricted our comparison to Taipei City and the 4 lowest densely populated counties, which also corroborated with the above results. The income elasticity analysis revealed when GDP per capita increased by 1%, the total SCI decreased by 1.39‰; which was also associated with a decrease of 1.34‰, 1.55‰, 1.36‰, 1.46‰, 1.54‰, 1.54‰, and 1.62‰ for traumatic SCI, MV-related SCI, fall-related SCI, tetraplegia, traumatic tetraplegia, MV-related tetraplegia, and fall-related tetraplegia respectively. The β coefficients show that the compared areas of urbanization level were also inversely correlated with CIR16–59 in the SCI population. Conclusions We conclude that the incidence of tetraplegia of traumatic SCI in Taiwan decreases with good economic performance, which may be resulted from the provision of public goods and services, possibly through improvements in the infrastructure of transportation and construction. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02141-8.
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Affiliation(s)
- Wei-Chih Lien
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan.,Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, 701, Taiwan.,Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung, 402, Taiwan
| | - Wei-Ming Wang
- Department of Statistics, College of Management, National Cheng Kung University, Tainan, 701, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, 701, Taiwan. .,Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, 704, Taiwan.
| | - Fuhmei Wang
- Department of Economics and Department of Public Health, National Cheng Kung University, Tainan, 701, Taiwan.
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Raguindin PF, Muka T, Glisic M. Sex and gender gap in spinal cord injury research: Focus on cardiometabolic diseases. A mini review. Maturitas 2021; 147:14-18. [PMID: 33832642 DOI: 10.1016/j.maturitas.2021.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/02/2020] [Accepted: 03/02/2021] [Indexed: 12/27/2022]
Abstract
Cardiometabolic disease (CMD) is among the leading causes of morbidity and mortality in people with a spinal cord injury (SCI). Despite well-acknowledged sex and gender differences in CMD in the general population, they remain insufficiently studied in persons with SCI. To describe the landscape of sex and gender in SCI research, we searched the literature for systematic reviews on cardiometabolic health in this population. Out of 15 systematic reviews identified, only 9 provided meaningful information on sex. Although one-quarter to one-fifth of the SCI population is female, women comprised only one-eighth to a quarter of study participants. A number of clinical studies purposively excluded women, to make the study population more homogenous. For those studies which included both sexes, in general, no sex-specific analyses were performed due to small sample sizes. All these reasons have contributed to the underrepresentation of females in the current body of evidence. Therefore, future studies should adopt a more sex- and gender-sensitive research framework to address cardiometabolic risk in SCI. Novel and advanced epidemiological methods should also be used, considering small sample sizes. Finally, collaborative research (through consortia and multi-center studies) should be encouraged to include more females. More inclusive research will ensure that everyone will benefit from scientific advancements, regardless of sex and gender.
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Affiliation(s)
- Peter Francis Raguindin
- Swiss Paraplegic Research, Nottwil, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Nottwil, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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Tan K, Koyama S, Sakurai H, Teranishi T, Kanada Y, Tanabe S. Wearable robotic exoskeleton for gait reconstruction in patients with spinal cord injury: A literature review. J Orthop Translat 2021; 28:55-64. [PMID: 33717982 PMCID: PMC7930505 DOI: 10.1016/j.jot.2021.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/25/2020] [Accepted: 01/07/2021] [Indexed: 12/13/2022] Open
Abstract
Objectives Wearable robotic exoskeletons (WREs) have been globally developed to achieve gait reconstruction in patients with spinal cord injury (SCI). The present study aimed to enable evidence-based decision-making in selecting the optimal WRE according to residual motor function and to provide a new perspective on further development of appropriate WREs. Methods The current review was conducted by searching PubMed, Web of Science, and Google Scholar for relevant studies published from April 2015 to February 2020. Selected studies were analysed with a focus on the participants’ neurological level of SCI, amount of training (number of training sessions and duration of the total training period), gait speed and endurance achieved, and subgroup exploration of the number of persons for assistance and the walking aid used among patients with cervical level injury. Results A total of 28 articles (nine using Ekso, three using Indego, ten using ReWalk, one using REX, five using Wearable Power-Assist Locomotor) involving 228 patients were included in the analysis. Across all WREs, T6 was the most frequently reported level of SCI. The amount of training showed a wide distribution (number of training sessions: 2–230 sessions [30–120 min per session]; duration of the total training period: 1–24 weeks [1–5 times per week]). The mean gait speed was 0.31 m/s (standard deviation [SD] 0.14), and the mean distance on the 6-min walking test as a measure of endurance was 108.9 m (SD 46.7). The subgroup exploration aimed at patients with cervical level injury indicated that 59.2% of patients were able to ambulate with no physical assistance and several patients used a walker as a walking aid. Conclusion The number of cervical level injury increased, as compared to the number previously indicated by a prior similar review. Training procedure was largely different among studies. Further improvement based on gait performance is required for use and dissemination in daily life. The translational potential of this article The present review reveals the current state of the clinical effectiveness of WREs for gait reconstruction in patients with SCI, contributing to evidence-based device application and further development.
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Affiliation(s)
- Koki Tan
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Soichiro Koyama
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Hiroaki Sakurai
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Toshio Teranishi
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Yoshikiyo Kanada
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
- Corresponding author.
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Toluse AM, Adeyemi TO. Epidemiology and clinical outcomes of spinal cord injuries at a level II trauma centre in Nigeria: a longitudinal five year study. Int Orthop 2021; 45:665-671. [PMID: 33443597 DOI: 10.1007/s00264-020-04898-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/03/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Spinal cord injuries (SCIs) are devastating consequences of traumatic injuries with far-reaching health and socioeconomic implications. The objectives of this study were to describe the epidemiological characteristics of traumatic SCI and to analyse these epidemiological and clinical characteristics. METHODS This study was a retrospective observational study. We extracted data from the medical records of all cases of acute traumatic SCI that presented at the hospital between January 2013 and December 2017. RESULTS We recorded 99 cases of traumatic SCI over the study period. The patients' mean age was 37.15 ± 13.5 years with a male predominance (68.7%). Working age group accounted for 83.9% of cases. Motor vehicular accident (MVA) and falls accounted for 62.6% and 22.2% respectively. About a third of the cases (32.3%) presented within 24 hours of injury. The most frequently affected level was the cervical spine (63.6%), and complete tetraplegia was the most prevalent clinical pattern (31.3%). American Spinal Injury Association impairment scale (AIS) improved in 31.3% of cases. Twenty-nine patients (30.2%) had morbidity, with 21.2% developing pressure sores. Mortality accounted for 3%. CONCLUSIONS Motor vehicular crash and fall-related traumatic SCI affected mostly males and the working age group with complete tetraplegia as the predominating clinical pattern. There is a need for strategic interventions to reduce MVA and improve pre-hospital care and health policies to ensure early definitive care.
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Affiliation(s)
- Adetunji M Toluse
- Department of Orthopaedic and Trauma Surgery, National Orthopaedic Hospital, PMB 2009, Igbobi, Yaba, Lagos, Nigeria.
| | - Taofeek O Adeyemi
- Department of Orthopaedic and Trauma Surgery, National Orthopaedic Hospital, PMB 2009, Igbobi, Yaba, Lagos, Nigeria
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Kalsi-Ryan S, Kapadia N, Gagnon DH, Verrier MC, Holmes J, Flett H, Farahani F, Alavinia SM, Omidvar M, Wiest MJ, Craven BC. Development of Reaching, Grasping & Manipulation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2021; 44:S134-S146. [PMID: 34779738 PMCID: PMC8604521 DOI: 10.1080/10790268.2021.1961052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To describe the development of structure, process, and outcome indicators aimed to advance the quality of Reaching, Grasping & Manipulation (RG&M) rehabilitation for Canadians living with spinal cord injury or disease (SCI/D). METHOD Upper extremity rehabilitation experts developed a framework of indicators for evaluation of RG&M rehabilitation quality. A systematic search of the literature identified potential upper extremity indicators that influence RG&M outcomes. A Driver diagram summarized factors influencing upper extremity outcomes to inform the selection of structure and process indicators. Psychometric properties, clinical utility, and feasibility of potential upper extremity measures were considered when selecting outcome indicators. RESULTS The selected structure indicator is the number of occupational and physical therapists with specialized certification, education, training and/or work experience in upper extremity therapy related to RG&M at a given SCI/D rehabilitation center. The process indicator is the total hours of upper extremity therapies related to RG&M and the proportion of this time allocated to neurorestorative therapy for each individual with tetraplegia receiving therapy. The outcome indicators are the Graded Redefined Assessment of Strength, Sensation and Prehension (GRASSP) strength and Spinal Cord Independence Measure III (SCIM III) Self-Care subscores implemented at rehabilitation admission and discharge, and SCIM III Self-Care subscore only at 18 months post-admission. CONCLUSION The selected indicators align with current practice, will direct the timing of routine assessments, and enhance the volume and quality of RG&M therapy delivered, with the aim to ultimately increase the proportion of individuals with tetraplegia achieving improved upper extremity function by 18 months post-rehabilitation.
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Affiliation(s)
- Sukhvinder Kalsi-Ryan
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Rocket Family Upper Extremity Clinic, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Naaz Kapadia
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Rocket Family Upper Extremity Clinic, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- CRANIA, University Health Network and University of Toronto, Toronto, Canada
| | - Dany H. Gagnon
- School of Rehabilitation, Université de Montréal, Montreal, Québec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain - CIUSSS du Centre-Sud-de-l’Ile-de-Montréal, Montreal, Québec, Canada
| | - Molly C. Verrier
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Holmes
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Heather Flett
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Farnoosh Farahani
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - S. Mohammad Alavinia
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maryam Omidvar
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Matheus J. Wiest
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Ontario Neurotrauma Foundation, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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