Is it time to redefine or rename the term “Central Cord Syndrome”?

The corticospinal tract (CST) is the preeminent voluntary motor pathway that controls human movements. Consequently, long-standing interest has focused on CST location and function in order to understand both loss and recovery of neurological function after incomplete cervical spinal cord injury, such as traumatic central cord syndrome. The hallmark clinical finding is paresis of the hands and upper-extremity function with retention of lower-extremity movements, which has been attributed to injury and the sparing of specific CST fibers. In contrast to historical concepts that proposed somatotopic (laminar) CST organization, the current narrative summarizes the accumulated evidence that 1) there is no somatotopic organization of the corticospinal tract within the spinal cord in humans and 2) the CST is critically important for hand function. The evidence includes data from 1) tract-tracing studies of the central nervous system and in vivo MRI studies of both humans and nonhuman primates, 2) selective ablative studies of the CST in primates, 3) evolutionary assessments of the CST in mammals, and 4) neuropathological examinations of patients after incomplete cervical spinal cord injury involving the CST and prominent arm and hand dysfunction. Acute traumatic central cord syndrome is characterized by prominent upper-extremity dysfunction, which has been falsely predicated on pinpoint injury to an assumed CST layer that specifically innervates the hand muscles. Given the evidence surveyed herein, the pathophysiological mechanism is most likely related to diffuse injury to the CST that plays a critically important role in hand function.

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Surgical Treatment Modalities for Cervical Stenosis: Central Cord Syndrome and Other Spinal Cord Injuries in the Elderly

The Comprehensive Treatment of the Aging Spine ◽

10.1016/b978-1-4377-0373-3.10027-2 ◽

2011 ◽

pp. 160-163 ◽

Cited By ~ 1

Author(s):

Michael Fehlings ◽

Randolph Gray

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Spinal Cord Injuries ◽

The Elderly ◽

Treatment Modalities ◽

Cervical Stenosis ◽

Central Cord Syndrome

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Significance of SCIWORA in adults

Coluna/Columna ◽

10.1590/s1808-1851201514020r130 ◽

2015 ◽

Vol 14 (2) ◽

pp. 134-137

Author(s):

Pedro Luis Bazán

Keyword(s):

Japanese Orthopaedic Association ◽

Prospective Evaluation ◽

Resonance Imaging ◽

Adult Age ◽

Intramedullary Lesion ◽

Central Cord Syndrome ◽

Asia Score ◽

The Relationship ◽

Cervical Arthrosis

<sec><title>OBJECTIVE:</title> Recognizing the importance of SCIWORA in adult age; analyze the usefulness of complementary studies; evaluating therapeutic options; learn about the evolution of the treated patients.</sec><sec><title>METHODS:</title> A prospective evaluation with a minimum follow-up of 5 years, eight elderly patients with cervical arthrosis and diagnosis of SCIWORA. The Japanese Orthopaedic Association (JOA) scale and ASIA were used on admission and at 6, 12, 24, 36, 48 and 60 months.</sec><sec><title>RESULTS:</title> The central cord syndrome (CCS) was the neurological condition at admission. One patient recovered after corticosteroid therapy, but later, his disability worsened, and he was operated at 18 months, another patient recovered and a third died. The other patients underwent laminoplasty in the first 72 hours; patients with partial severity condition had a minimum improvement of five points in JAO scale and those with severe conditions died.</sec><sec><title>CONCLUSIONS:</title> The low-energy trauma can decompensate the relationship between container and content in the spine with asymptomatic arthrosis, and can be devastating to the patient. The diagnosis of intramedullary lesion is made by magnetic resonance imaging. Patients with incomplete deficit undergoing laminoplasty reached at least one level in ASIA score. The potential postoperative complications can be serious.</sec>

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Myoelectric Control Techniques for a Rehabilitation Robot

Applied Bionics and Biomechanics ◽

10.1155/2011/143016 ◽

2011 ◽

Vol 8 (1) ◽

pp. 21-37 ◽

Cited By ~ 13

Author(s):

Alan Smith ◽

Edward E. Brown

Keyword(s):

Healthy Subjects ◽

Sagittal Plane ◽

Robot Manipulator ◽

Wrist Joint ◽

Elbow Flexion ◽

Myoelectric Control ◽

Average Error ◽

Rehabilitation Robot ◽

Control Scheme ◽

Central Cord Syndrome

This work examines two different types of myoelectric control schemes for the purpose of rehabilitation robot applications. The first is a commonly used technique based on a Gaussian classifier. It is implemented in real time for healthy subjects in addition to a subject with Central Cord Syndrome (CCS). The myoelectric control scheme is used to control three degrees of freedom (DOF) on a robot manipulator which corresponded to the robot's elbow joint, wrist joint, and gripper. The classes of motion controlled include elbow flexion and extension, wrist pronation and supination, hand grasping and releasing, and rest. Healthy subjects were able to achieve 90% accuracy. Single DOF controllers were first tested on the subject with CCS and he achieved 100%, 96%, and 85% accuracy for the elbow, gripper, and wrist controllers respectively. Secondly, he was able to control the three DOF controller at 68% accuracy. The potential applications for this scheme are rehabilitation and teleoperation. To overcome limitations in the pattern recognition based scheme, a second myoelectric control scheme is also presented which is trained using electromyographic (EMG) data derived from natural reaching motions in the sagittal plane. This second scheme is based on a time delayed neural network (TDNN) which has the ability to control multiple DOF at once. The controller tracked a subject's elbow and shoulder joints in the sagittal plane. Results showed an average error of 19° for the two joints. This myoelectric control scheme has the potential of being used in the development of exoskeleton and orthotic rehabilitation applications.

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