scholarly journals Maximum movement and cumulative movement (travel) to inform our understanding of secondary spinal cord injury and its application to collar use in self-extrication

Author(s):  
Tim Nutbeam ◽  
Rob Fenwick ◽  
Barbara May ◽  
Willem Stassen ◽  
Jason Smith ◽  
...  

Abstract Background Motor vehicle collisions remain a common cause of spinal cord injury. Biomechanical studies of spinal movement often lack “real world” context and applicability. Additional data may enhance our understanding of the potential for secondary spinal cord injury. We propose the metric ‘travel’ (total movement) and suggest that our understanding of movement related risk of injury could be improved if travel was routinely reported. We report maximal movement and travel for collar application in vehicle and subsequent self-extrication. Methods Biomechanical data on application of cervical collar with the volunteer sat in a vehicle were collected using Inertial Measurement Units on 6 healthy volunteers. Maximal movement and travel are reported. These data and a re-analysis of previously published work is used to demonstrate the utility of travel and maximal movement in the context of self-extrication. Results Data from a total of 60 in-vehicle collar applications across three female and three male volunteers was successfully collected for analysis. The mean age across participants was 50.3 years (range 28–68) and the BMI was 27.7 (range 21.5–34.6). The mean maximal anterior–posterior movement associated with collar application was 2.3 mm with a total AP travel of 4.9 mm. Travel (total movement) for in-car application of collar and self-extrication was 9.5 mm compared to 9.4 mm travel for self-extrication without a collar. Conclusion We have demonstrated the application of ‘travel’ in the context of self-extrication. Total travel is similar across self-extricating healthy volunteers with and without a collar. We suggest that where possible ‘travel’ is collected and reported in future biomechanical studies in this and related areas of research. It remains appropriate to apply a cervical collar to self-extricating casualties when the clinical target is that of movement minimisation.

2021 ◽  
Author(s):  
Tim Nutbeam ◽  
Rob Fenwick ◽  
Barbara May ◽  
Willem Stassen ◽  
Jason Smith ◽  
...  

Abstract Background:Motor vehicle collisions remain a common cause of spinal cord injury. Biomechanical studies of spinal movement often lack “real world” context and applicability. Additional data may enhance our understanding of the potential for secondary spinal cord injury. We propose the metric ‘travel’ (total movement) and suggest that our understanding of movement related risk of injury could be improved if travel was routinely reported. We report maximal movement and travel for collar application in vehicle and subsequent self-extrication.Methods:Biomechanical data on application of cervical collar with the volunteer sat in a vehicle were collected using Inertial Measurement Units on 6 healthy volunteers. Maximal movement and travel are reported. These data and a re-analysis of previously published work is used to demonstrate the utility of travel and maximal movement in the context of self-extrication.Results:Data from a total of 60 in-vehicle collar applications across three female and three male volunteers was successfully collected for analysis. The mean age across participants was 50.3 years (range 28–68) and the BMI was 27.7 (range 21.5–34.6). The mean maximal anterior-posterior movement associated with collar application was 2.3mm with a total AP travel of 4.9mm. Travel (total movement) for in-car application of collar and self-extrication was 9.5mm compared to 9.4mm travel for self-extrication without a collar. Conclusion:We have demonstrated the application of ‘travel’ in the context of self-extrication. Total travel is similar across self-extricating healthy volunteers with and without a collar.We suggest that where possible ‘travel’ is collected and reported in future biomechanical studies in this and related areas of research. It remains appropriate to apply a cervical collar to self-extricating casualties when the clinical target is that of movement minimisation.


Author(s):  
Tim Nutbeam ◽  
Rob Fenwick ◽  
Barbara May ◽  
Willem Stassen ◽  
Jason E. Smith ◽  
...  

Abstract Background Motor vehicle collisions account for 1.3 million deaths and 50 million serious injuries worldwide each year. However, the majority of people involved in such incidents are uninjured or have injuries which do not prevent them exiting the vehicle. Self-extrication is the process by which a casualty is instructed to leave their vehicle and completes this with minimal or no assistance. Self-extrication may offer a number of patient and system-wide benefits. The efficacy of routine cervical collar application for this group is unclear and previous studies have demonstrated inconsistent results. It is unknown whether scripted instructions given to casualties on how to exit the vehicle would offer any additional utility. The aim of this study was to evaluate the effect of cervical collars and instructions on spinal movements during self-extrication from a vehicle, using novel motion tracking technology. Methods Biomechanical data on extrications were collected using Inertial Measurement Units on 10 healthy volunteers. The different extrication types examined were: i) No instructions and no cervical collar, ii) No instructions, with cervical collar, iii) With instructions and no collar, and iv) With instructions and with collar. Measurements were recorded at the cervical and lumbar spine, and in the anteroposterior (AP) and lateral (LAT) planes. Total movement, mean, standard deviation and confidence intervals are reported for each extrication type. Results Data were recorded for 392 extrications. The smallest cervical spine movements were recorded when a collar was applied and no instructions were given: mean 6.9 mm AP and 4.4 mm LAT. This also produced the smallest movements at the lumbar spine with a mean of 122 mm AP and 72.5 mm LAT. The largest overall movements were seen in the cervical spine AP when no instructions and no collar were used (28.3 mm). For cervical spine lateral movements, no collar but with instructions produced the greatest movement (18.5 mm). For the lumbar spine, the greatest movement was recorded when instructions were given and no collar was used (153.5 mm AP, 101.1 mm LAT). Conclusions Across all participants, the most frequently occurring extrication method associated with the least movement was no instructions, with a cervical collar in situ.


Neurosurgery ◽  
2015 ◽  
Vol 77 (4) ◽  
pp. 561-565 ◽  
Author(s):  
Victor Chang ◽  
Benjamin M. Ellingson ◽  
Noriko Salamon ◽  
Langston T. Holly

Abstract BACKGROUND: Cervical stenosis patients are commonly advised to undergo surgery due to the risk of spinal cord injury (SCI) after a traumatic event. However, the actual risk of SCI in this scenario is unknown. OBJECTIVE: To evaluate the risk of SCI after minor trauma in a cohort of prospectively followed cervical stenosis patients. METHODS: Clinical and radiographical analysis was performed in 55 nonoperatively treated patients evaluated between 2009 and 2014. Each patient was asked standardized questions including: 1) whether a previous physician recommended neck surgery, 2) whether a physician indicated that they would become paralyzed after a traumatic event, and 3) whether they experienced a traumatic event during the follow-up period. RESULTS: The mean age was 65, with a mean modified Japanese Orthopedic Association score of 16.6. The mean canal diameter was 6.1 mm. Nineteen patients (35%) had evidence of intramedullary T2 signal abnormality. Thirty-one patients (56%) were previously recommended for surgery. Twenty-six patients (47%) were told that they would be paralyzed after a motor vehicle accident or fall unless surgery was performed. Ten patients (18%) experienced a traumatic event during the follow-up, with none sustaining an SCI. CONCLUSION: Asymptomatic and mildly symptomatic cervical stenosis patients are commonly recommended to undergo surgery due to risk of paralysis after a traumatic event. SCI was not observed after minor trauma in our cohort of prospectively followed patients. It seems that occurrence of SCI in this patient population after minor trauma is likely smaller than many physicians surmise, yet will require future prospective study in a large cohort of patients.


2021 ◽  
Vol 45 (1) ◽  
pp. 7-15
Author(s):  
Ha Seong Kim ◽  
Kil-Byung Lim ◽  
Jiyong Kim ◽  
Joongmo Kang ◽  
Hojin Lee ◽  
...  

Objective To investigate the epidemiologic and demographic characteristics of patients with spinal cord injury (SCI) who were admitted to a department of rehabilitation of a university hospital.Methods This was a descriptive cross-sectional study. Medical records including sex, age at injury, type of disability, traumatic or non-traumatic etiology and presence of ossification of posterior longitudinal ligament (OPLL) of patients with SCI who were admitted to the department of rehabilitation between 2012 and 2018 were reviewed.Results Of the 221 cases of SCI, 161 were traumatic and 60 were non-traumatic. The mean age at injury was 52.8 years. People aged 40–49 years showed highest proportion among overall SCI patients (19.0%). The proportion of male patients was higher in traumatic SCI at 4.96:1 than in non-traumatic SCI at 1.30:1. The most common cause of traumatic SCI was falling off (37.3%), followed by motor vehicle crash (35.4%) and tripping over (19.3%). Meanwhile, the most common cause of non-traumatic SCI was neoplasm (35.0%). Tripping over was the leading cause of traumatic SCI in patients aged ≥60 years (42.6%). A high proportion of traumatic SCI patients were found to have underlying OPLL (26.1%), particularly those who were injured by tripping over (64.5%).Conclusion The mean age of SCI patients was higher than that of previous studies. Falls was the single most common cause of traumatic SCI, and tripping over was the most common cause of injury in the elderly patients. OPLL was prevalent in patients who were injured from tripping over.


2021 ◽  
pp. 26
Author(s):  
Teif Almohimeed

Introduction: Occupational therapy (OT) is a part of rehabilitation that facilitates and enables individuals with traumatic spinal cord injuries (TSCI) to engage in daily occupations independently. Little is known about the type of OT treatment plan and the amount of time spent selecting the treatment intervention during TSCI rehabilitation. This study aimed to describe the overall time spent by patients with TSCI throughout their inpatient rehabilitation stay. Methodology: A chart review was conducted of patients attending inpatient rehabilitation for TSCI at King Abdulaziz Medical City between 2016 and 2020. For each patient, an electronic medical file, the documented rehabilitation session, including the time spent and type of therapeutic activity, were extracted. Demographic, clinical data related to the type of injury and the level of spinal cord injury (SCI) involved were also collected. We estimated the time that each patient had among all sessions and examined it with clinical factors. Result: A total of 50 eligible patients were included in this analysis. The mean age of the study population was 28 (interquartile range [IQR], 22–41) years, and the majority were male patients (82%). The most common reason for the SCI was a motor vehicle accident (94%), in which 56% required ICU admission. Among the study population, 58% had paraplegia and 42% had quadriplegia. The most common specific therapeutic activity was education (100%), equipment prescription (96%), transfer training 86%, and toilet training (70%). The mean total time spent over the patients’ entire stay was 1785 min (IQR 660–3300 min), with approximately 43.7 hr (SD 52 hr) of occupational rehabilitation. After categorizing the spinal cord injury, a mean total of 33 (IQR, 20–110) hr of session was received for patients who had an SCI level between C1 and C4 over the course of rehabilitation, and this was 25 (IQR, 15–32) hr of session for patients with an SCI level between C5 and C8, 36 (IQR, 5–8) hr of session for patients with an SCI level of <T1–T6, and 29 (IQR, 5–53) hr of session for patients with an SCI level of <T6. Conclusion: Almost all patients with TSCI participated in strengthening/Range of Motion (ROM) exercises and Activities of Daily Living (ADLs) training during OT treatment; these two were the most time-consuming interventions. When examining therapy, we found that lower body dressing training was the most time-consuming ADL. Significant variation were seen in time spent among TSCI for all OT interventions when examining both the total time spent and a calculated number of minutes per session. Some of this variation could be explained by patient and injury characteristics.


2014 ◽  
Vol 31 (24) ◽  
pp. 1967-1974 ◽  
Author(s):  
Daisuke Umebayashi ◽  
Atsushi Natsume ◽  
Hideyuki Takeuchi ◽  
Masahito Hara ◽  
Yusuke Nishimura ◽  
...  

2021 ◽  
Vol 15 ◽  
Author(s):  
Yang Liu ◽  
Grace Hammel ◽  
Minjun Shi ◽  
Zhijian Cheng ◽  
Sandra Zivkovic ◽  
...  

Although the increased expression of members of the chondroitin sulfate proteoglycan family, such as neuron-glial antigen 2 (NG2), have been well documented after an injury to the spinal cord, a complete picture as to the cellular origins and function of this NG2 expression has yet to be made. Using a spinal cord injury (SCI) mouse model, we describe that some infiltrated bone marrow-derived macrophages (BMDMΦ) are early contributors to NG2/CSPG4 expression and secretion after SCI. We demonstrate for the first time that a lesion-related form of cellular debris generated from damaged myelin sheaths can increase NG2/CSPG4 expression in BMDMΦ, which then exhibit enhanced proliferation and decreased phagocytic capacity. These results suggest that BMDMΦ may play a much more nuanced role in secondary spinal cord injury than previously thought, including acting as early contributors to the NG2 component of the glial scar.


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