scholarly journals Toronto Rehabilitation Institute–Hand Function Test: Assessment of Gross Motor Function in Individuals With Spinal Cord Injury

2012 ◽  
Vol 18 (2) ◽  
pp. 167-186 ◽  
Author(s):  
Naaz Kapadia ◽  
Vera Zivanovic ◽  
Molly Verrier ◽  
Milos Popovic
Author(s):  
Samer Augusto De Sousa ◽  
Consuelo Volpato Quilice ◽  
Lucas Renato Franzoni ◽  
Sandra Leite Alves ◽  
Marluci Benini Bezzan ◽  
...  

A lesão medular é uma alteração incapacitante, caracterizada por interrupção parcial ou total dos estímulos neurológicos através da medula. No processo de reabilitação, o fisioterapeuta pode se utilizar de vários recursos para melhora funcional do paciente, como as técnicas conhecidas de eletroestimulação funcional e a facilitação neuromuscular proprioceptiva (FNP). O objetivo deste trabalho foi verificar a eficácia da eletroestimulação funcional (FES) associada à FNP na melhora funcional dos membros superiores de um paciente tetraplégico. Para tal, um paciente com lesão medular foi submetido a 20 sessões de tratamento com FES, associado à FNP nos membros superiores, duas vezes por semana, com duração de 40 minutos. Para a obtenção dos resultados, o paciente foi avaliado, inicialmente, pela escala da Ásia para determinar o nível neurológico da lesão, e pela escala Wolf Motor Function Test (WMFT). Como resultado, observou-se uma melhora bilateral da capacidade de realizar atividades funcionais, destacando assim as tarefas que exigiram movimentos mais precisos, como dobrar toalhas e levantar cesta. Conclui-se que, no caso do paciente estudado, a FES associada à FNP proporcionou melhora funcional dos membros superiores de um paciente com lesão medular.Palavras-chave: Lesão Medular. FES. FNP. Fisioterapia.AbstractSpinal cord injury is a disabling alteration, characterized by partial or total disruption of neurological stimuli through the medulla. In the rehabilitation process the physiotherapist may use several resources for the patient’s functional improvement, such as the so-called techniques of electrostimulation functional and proprioceptive neuromuscular facilitation (PNF). The objective of this work was to verify the influence of the association of functional electrostimulation (FES) with the PNF in the functional improvement of the upper members of a tetraplegic patient. For such, a patient with spinal cord injury was submitted to 20 sessions of treatment with FES associated to the PNF in the upper limbs, twice a week, with duration of 40 minutes. For obtaining the results, the patient was assessed initially by the scale of Asia to determine the neurological level of the lesion, and by scale Wolf Motor Function Test (WMFT). As results a bilaterally improvement in the ability to perform functional activities was observed, thus highlighting the tasks that demanded more precise movements, such as to fold towels and raise basket, where the patient obtained 2 in pre treatment and 4 evaluation in the post-treatment bilaterally. It is concluded that, in the case of the studied patient, FES associated with PNF gave functional improvements of the patient’s upper members with spinal cord injuries.Keywords: Spinal Cord Injury. FES. PNF. Physical Therapy.


2021 ◽  
pp. 096032712110033
Author(s):  
Liying Fan ◽  
Jun Dong ◽  
Xijing He ◽  
Chun Zhang ◽  
Ting Zhang

Spinal cord injury (SCI) is one of the most common destructive injuries, which may lead to permanent neurological dysfunction. Currently, transplantation of bone marrow mesenchymal stem cells (BMSCs) in experimental models of SCI shows promise as effective therapies. BMSCs secrete various factors that can regulate the microenvironment, which is called paracrine effect. Among these paracrine substances, exosomes are considered to be the most valuable therapeutic factors. Our study found that BMSCs-derived exosomes therapy attenuated cell apoptosis and inflammation response in the injured spinal cord tissues. In in vitro studies, BMSCs-derived exosomes significantly inhibited lipopolysaccharide (LPS)-induced PC12 cell apoptosis, reduced the secretion of pro-inflammatory factors including tumor necrosis factor (TNF)-α and IL (interleukin)-1β and promoted the secretion of anti-inflammatory factors including IL-10 and IL-4. Moreover, we found that LPS-induced protein expression of toll-like receptor 4 (TLR4), myeloid differentiation factor 88 (MyD88) and nuclear transcription factor-κB (NF-κB) was significantly downregulated after treatment with BMSCs-derived exosomes. In in vivo studies, we found that hindlimb motor function was significantly improved in SCI rats with systemic administration of BMSCs-derived exosomes. We also observed that the expression of pro-apoptotic proteins and pro-inflammatory factors was significantly decreased, while the expression of anti-apoptotic proteins and anti-inflammatory factors were upregulated in SCI rats after exosome treatment. In conclusion, BMSCs-derived exosomes can inhibit apoptosis and inflammation response induced by injury and promote motor function recovery by inhibiting the TLR4/MyD88/NF-κB signaling pathway, which suggests that BMSCs-derived exosomes are expected to become a new therapeutic strategy for SCI.


2020 ◽  
Vol 1 ◽  
Author(s):  
Youngmok Yun ◽  
Youngjin Na ◽  
Paria Esmatloo ◽  
Sarah Dancausse ◽  
Alfredo Serrato ◽  
...  

Abstract We have developed a one-of-a-kind hand exoskeleton, called Maestro, which can power finger movements of those surviving severe disabilities to complete daily tasks using compliant joints. In this paper, we present results from an electromyography (EMG) control strategy conducted with spinal cord injury (SCI) patients (C5, C6, and C7) in which the subjects completed daily tasks controlling Maestro with EMG signals from their forearm muscles. With its compliant actuation and its degrees of freedom that match the natural finger movements, Maestro is capable of helping the subjects grasp and manipulate a variety of daily objects (more than 15 from a standardized set). To generate control commands for Maestro, an artificial neural network algorithm was implemented along with a probabilistic control approach to classify and deliver four hand poses robustly with three EMG signals measured from the forearm and palm. Increase in the scores of a standardized test, called the Sollerman hand function test, and enhancement in different aspects of grasping such as strength shows feasibility that Maestro can be capable of improving the hand function of SCI subjects.


2021 ◽  
pp. 113831
Author(s):  
Chun Cui ◽  
Lin-Fang Wang ◽  
Shu-Bing Huang ◽  
Peng Zhao ◽  
Yong-Quan Chen ◽  
...  

2021 ◽  
pp. 1-7
Author(s):  
Allan D. Levi ◽  
Jan M. Schwab

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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