Neuroprotection for Spinal Cord Injury

2017 ◽  
Author(s):  
Christopher S. Ahuja ◽  
Michael Fehlings
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Current Evidence ◽  
Mechanical Trauma ◽  
Secondary Injury ◽  
Loss Of Function ◽  
Cord Injury ◽  
Death And Loss

Traumatic spinal cord injuries (SCI) often have a devastating impact on quality of life for patients and their families. Neuroprotection for spinal cord injury is aimed at improving functional outcomes by limiting secondary injury processes that occur within the first minutes, hours, and days following the primary injury. The primary mechanical trauma initiates a secondary injury cascade where ischemia, inflammatory cell infiltration, and cytotoxic changes in the microenvironment cause further cell death and loss of function. Time-sensitive neuroprotective measures targeting these secondary insults have emerged as key therapeutic strategies. This chapter summarizes current evidence-based neuroprotective treatments, such as blood pressure augmentation, early surgical decompression, and intravenous methylprednisolone, as well as important emerging interventions, including therapeutic hypothermia, sodium channel blockade using riluzole, and the anti-inflammatory actions of minocycline. The chapter concludes by summarizing the current guidelines that all practitioners should be well-versed in prior to providing care for patients with SCI.

Physical Activity, Quality of Life, and Functional Autonomy of Adults With Spinal Cord Injuries

2013 ◽  
Vol 30 (4) ◽  
pp. 317-337 ◽  
Author(s):  
Camilla Yuri Kawanishi ◽  
Márcia Greguol
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Functional Independence ◽  
Cord Injury ◽  
Functional Autonomy ◽  
Using Data

This study aimed to perform a systematic review of studies that address the influence of physical activity on the quality of life and functional independence of adult individuals with spinal cord injury. The review was performed using data obtained from the MEDLINE, CINAHL, SciELO, LILACS, SPORTDiscus, Web of Science, Academic Search Premier, and PEDro databases using the following keywords: quality of life; functional independence; autonomy; independence; physical activity; activities of daily living; physical exercise; tetraplegia; paraplegia; spinal cord injury; physical disabilities; and wheelchair. Eleven studies met the inclusion criteria. Although there was a lack of consensus among the selected studies, the majority of them presented a strong correlation between physical activity and variables of quality of life and/or functional independence. Thus, physical activity appears to have an important influence on social relationships, functional independence, psychological factors, and physical aspects, which can enhance quality of life and independence in the performance of daily activities.

scholarly journals Complex clinical and therapeutic rehabilitation approach of a patient with complete AIS/Frankel A tetraplegia post cervical spinal cord injury after accidental fall off a trailer and multiple complications occurring during disease progression - case study

2019 ◽  
Vol 10 (Vol 10 No. 4) ◽  
pp. 564-566
Author(s):  
Irina ANGHEL ◽  
Alexandra SPORICI ◽  
Magdalena LAPADAT ◽  
Gelu ONOSE
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Respiratory Distress ◽  
Spinal Cord Injuries ◽  
Wide Spectrum ◽  
Burst Fracture ◽  
Fracture Dislocation ◽  
Cord Injury

Introduction: Spinal cord injury is a complex neurologic condition that embeds multiple complications, which are often debilitating for patients as the disease progresses. Materials and Methods: This paper presents a case of a 44-year-old patient with a longilin asthenic constitution and no previous medical history, who accidentally fell off a trailer resulting in burst fracture dislocation of C6/C7 associated with immediate loss and consciousness and onset of complete ASIA-A tetraplegia with C5 neurologic level. The patient received a complex nursing program, which included extensive debridement of the necrotic tissue, daily antiseptic wound dressing using Chloramine solution and silver sulfadiazine cream along with wide-spectrum antibiotic therapy with slow but favorable progression. During hospitalization the patient developed an episode of respiratory distress which responded favorably to Levocetirizine daily. Results: The complex neuro-muscular rehabilitation program along with the medical treatment and surgical debridement the patient received have improved of the clinical outcome with the shrinkage of the pressure point lesions, adequate respiratory function which permitted the mobilization of the patient with the wheelchair. Conclusions: Patients with spinal cord injuries are prone to a vast majority of complications including pressure sores complicated with necrotizing fasciitis and respiratory distress that could alter the quality of life. Proper monitoring and management of these kind of complications in the context of neuromuscular rehabilitation are necessary for the enhancement of the quality of life. Key words: spinal cord injury, tetraplegia, complications,

scholarly journals Recent advances in managing a spinal cord injury secondary to trauma

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 1017 ◽  
Author(s):  
Christopher S. Ahuja ◽  
Allan R. Martin ◽  
Michael G Fehlings
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Management Practices ◽  
Spinal Cord Injuries ◽  
Surgical Care ◽  
Mechanical Trauma ◽  
Cell Therapies ◽  
North Americans ◽  
Cord Injury ◽  
Pathway Inhibition

Traumatic spinal cord injuries (SCIs) affect 1.3 million North Americans, producing devastating physical, social, and vocational impairment. Pathophysiologically, the initial mechanical trauma is followed by a significant secondary injury which includes local ischemia, pro-apoptotic signaling, release of cytotoxic factors, and inflammatory cell infiltration. Expedient delivery of medical and surgical care during this critical period can improve long-term functional outcomes, engendering the concept of “Time is Spine”. We emphasize the importance of expeditious care while outlining the initial clinical and radiographic assessment of patients. Key evidence-based early interventions (surgical decompression, blood pressure augmentation, and methylprednisolone) are also reviewed, including findings of the landmark Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). We then describe other neuroprotective approaches on the edge of translation such as the sodium-channel blocker riluzole, the anti-inflammatory minocycline, and therapeutic hypothermia. We also review promising neuroregenerative therapies that are likely to influence management practices over the next decade including chondroitinase, Rho-ROCK pathway inhibition, and bioengineered strategies. The importance of emerging neural stem cell therapies to remyelinate denuded axons and regenerate neural circuits is also discussed. Finally, we outline future directions for research and patient care.

scholarly journals The benefits of hydrotherapy to patients with spinal cord injuries

2018 ◽  
Vol 7 ◽  
Author(s):  
Terry J. Ellapen ◽  
Henriëtte V. Hammill ◽  
Mariëtte Swanepoel ◽  
Gert L. Strydom
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Full Text ◽  
Spinal Cord Injuries ◽  
Cardiovascular Responses ◽  
Well Being ◽  
Gait Kinematics ◽  
Cord Injury ◽  
The Impact

Background: Many patients with spinal cord injury (PWSCI) lead sedentary lifestyles, experiencing poor quality of life and medical challenges. PWSCI don’t like to participate in land-based-exercises because it’s tedious to perform the same exercises, decreasing their rehabilitative compliance and negatively impacting their well-being. An alternative exercise environment and exercises may alleviate boredom, enhancing compliance.Objectives: Discuss the benefits of hydrotherapy to PWSCI concerning underwater gait-kinematics, thermoregulatory and cardiovascular responses and spasticity.Methodology: A literature surveillance was conducted between 1998 and 2017, through the Crossref meta-database and Google Scholar, according to the PRISMA procedures. Key search words were water-therapy, aquatic-therapy, hydrotherapy, spinal cord injury, rehabilitation, human, kinematics, underwater gait, cardiorespiratory, thermoregulation and spasticity. The quality of each paper was evaluated using a modified Downs and Black Appraisal Scale. The participants were records pertaining to PWSCI and hydrotherapy. The outcomes of interest were: hydrotherapy interventions, the impact of hydrotherapy on gait-kinematics, thermoregulation during water submersion and cardiorespiratory function of PWSCI. Omitted records included: non-English publications from before 1998 or unrelated to hydrotherapy and PWSCI. The record screening admissibility was performed as follows: the title screen, the abstract screen and the full text screen.Results: Literature search identified 1080 records. Upon application of the exclusion criteria, 92 titles, 29 abstracts and 17 full text records were eligible. Only 15 records were selected to be included in this clinical commentary. Evidence shows a paucity of randomised control trials (RCT) conducted in this field.Conclusion: Hydrotherapy improves PWSCI underwater gait-kinematics, cardiorespiratory and thermoregulatory responses and reduces spasticity.

Impairment Rating and Spinal Cord Injuries: Revisiting the Guides

2010 ◽  
Vol 15 (3) ◽  
pp. 1-7
Author(s):  
Richard T. Katz
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Functional Independence ◽  
Outcome Data ◽  
Multiple Organ ◽  
Loss Of Function ◽  
Sixth Edition ◽  
Organ Systems ◽  
Cord Injury ◽  
Impairment Ratings

Abstract This article addresses some criticisms of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) by comparing previously published outcome data from a group of complete spinal cord injury (SCI) persons with impairment ratings for a corresponding level of injury calculated using the AMA Guides, Sixth Edition. Results of the comparison show that impairment ratings using the sixth edition scale poorly with the level of impairments of activities of daily living (ADL) in SCI patients as assessed by the Functional Independence Measure (FIM) motor scale and the extended FIM motor scale. Because of the combinations of multiple impairments, the AMA Guides potentially overrates the impairment of paraplegics compared with that of quadriplegics. The use and applicability of the Combined Values formula should be further investigated, and complete loss of function of two upper extremities seems consistent with levels of quadriplegia using the SCI model. Some aspects of the AMA Guides contain inconsistencies. The concept of diminishing impairment values is not easily translated between specific losses of function per organ system and “overall” loss of ADLs involving multiple organ systems, and the notion of “catastrophic thresholds” involving multiple organ systems may support the understanding that variations in rating may exist in higher rating cases such as those that involve an SCI.

scholarly journals Exoskeletons, Rehabilitation and Bodily Capacities

2021 ◽  
pp. 1357034X2110256
Author(s):  
Denisa Butnaru
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Crucial Role ◽  
Spinal Cord Injuries ◽  
Main Task ◽  
Cerebrovascular Accidents ◽  
Complex Processes ◽  
Cord Injury ◽  
Neurological Conditions

Motility impairments resulting from spinal cord injuries and cerebrovascular accidents are increasingly prevalent in society, leading to the growing development of rehabilitative robotic technologies, among them exoskeletons. This article outlines how bodies with neurological conditions such as spinal cord injury and stroke engage in processes of re-appropriation while using exoskeletons and some of the challenges they face. The main task of exoskeletons in rehabilitative environments is either to rehabilitate or ameliorate anatomic functions of impaired bodies. In these complex processes, they also play a crucial role in recasting specific corporeal phenomenologies. For the accomplishment of these forms of corporeal re-appropriation, the role of experts is crucial. This article explores how categories such as bodily resistance, techno-inter-corporeal co-production of bodies and machines, as well as body work mark the landscape of these contemporary forms of impaired corporeality. While defending corporeal extension rather than incorporation, I argue against the figure of the ‘cyborg’ and posit the idea of ‘residual subjectivity’.

Sign in / Sign up

Export Citation Format

Share Document