scholarly journals Locomotor Training Restores Walking in a Nonambulatory Child With Chronic, Severe, Incomplete Cervical Spinal Cord Injury

2008 ◽  
Vol 88 (5) ◽  
pp. 580-590 ◽  
Author(s):  
Andrea L Behrman ◽  
Preeti M Nair ◽  
Mark G Bowden ◽  
Robert C Dauser ◽  
Benjamin R Herget ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Nervous System ◽  
Lower Extremity ◽  
Gait Speed ◽  
Spinal Cord Injuries ◽  
Maximum Speed ◽  
Locomotor Training ◽  
Full Time ◽  
Cord Injury ◽  
Community Ambulation

Background and Purpose Locomotor training (LT) enhances walking in adult experimental animals and humans with mild-to-moderate spinal cord injuries (SCIs). The animal literature suggests that the effects of LT may be greater on an immature nervous system than on a mature nervous system. The purpose of this study was to evaluate the effects of LT in a child with chronic, incomplete SCI. Subject The subject was a nonambulatory 4½-year-old boy with an American Spinal Injury Association Impairment Scale (AIS) C Lower Extremity Motor Score (LEMS) of 4/50 who was deemed permanently wheelchair-dependent and was enrolled in an LT program 16 months after a severe cervical SCI. Methods A pretest-posttest design was used in the study. Over 16 weeks, the child received 76 LT sessions using both treadmill and over-ground settings in which graded sensory cues were provided. The outcome measures were ASIA Impairment Scale score, gait speed, walking independence, and number of steps. Result One month into LT, voluntary stepping began, and the child progressed from having no ability to use his legs to community ambulation with a rolling walker. By the end of LT, his walking independence score had increased from 0 to 13/20, despite no change in LEMS. The child's final self-selected gait speed was 0.29 m/s, with an average of 2,488 community-based steps per day and a maximum speed of 0.48 m/s. He then attended kindergarten using a walker full-time. Discussion and Conclusion A simple, context-dependent stepping pattern sufficient for community ambulation was recovered in the absence of substantial voluntary isolated lower-extremity movement in a child with chronic, severe SCI. These novel data suggest that some children with severe, incomplete SCI may recover community ambulation after undergoing LT and that the LEMS cannot identify this subpopulation.

scholarly journals Progress in research into spinal cord injury repair: Tissue engineering scaffolds and cell transdifferentiation

2019 ◽  
Vol 07 (04) ◽  
pp. 196-206 ◽  
Author(s):  
Changke Ma ◽  
Peng Zhang ◽  
Yixin Shen
Keyword(s):  
Spinal Cord ◽  
Tissue Engineering ◽  
Central Nervous System ◽  
Nervous System ◽  
Spinal Cord Injuries ◽  
Materials Science ◽  
Regeneration Ability ◽  
Spinal Cord Tissue ◽  
Cell Transdifferentiation ◽  
Cord Injury

As with all tissues of the central nervous system, the low regeneration ability of spinal cord tissue after injury decreases the potential for repair and recovery. Initially, in spinal cord injuries (SCI), often the surgeon can only limit further damage by early surgical decompression. However, with the development of basic science, especially the development of genetic engineering, molecular biology, tissue engineering, and materials science, some promising progress has been made in promoting the repair of central nervous system injuries. For example, transplantation of neural stem cells (NSCs), olfactory ensheathing cells (OECs), and gene- mediated transdifferentiation to repair central nervous system injury. This paper summarizes the progress and prospects of SCI repair with tissue engineering scaffold and cell transdifferentiation from an extensive literatures.

Paraplegia, Quadriplegia and Employment in Australia

1996 ◽  
Vol 5 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Gregory Murphy ◽  
Douglas Brown ◽  
Peter Foreman ◽  
Amanda Young ◽  
James Athanasou
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Full Time ◽  
Post Injury ◽  
Employment Services ◽  
Cord Injury ◽  
Working Age ◽  
Part Time ◽  
Initial Hospital

The educational and vocational achievements of a sample of Australians with spinal cord injuries are described in this study. Of the 180 working-age people surveyed, 36% were holding full-time or part-time employment at the time of the survey and one-third had gone on to obtain further qualifications post-injury. The most frequent methods of finding a job post-injury were informal rather than formal, with only 5% of jobs gained through advertisements or employment services. Of those who gained work, 49% did so within 12 months of discharge, but another 14% obtained their job more than five years after initial hospital discharge. The results indicate that there is considerable scope for employment and education achievements following spinal cord injury.

Spinal Cord Injuries the Facts of Neuropathology: Opportunities and Limitations

2019 ◽  
Vol 1 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Byron A Kakulas
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Nervous System ◽  
Wallerian Degeneration ◽  
Spinal Cord Injuries ◽  
Neurological Status ◽  
Research Projects ◽  
Human Spinal Cord ◽  
The Third ◽  
Cord Injury

It is essential for research projects which are undertaken to find a “cure” for human spinal cord injury (SCI) to be consistent with the neuropathological facts of the disorder. In this respect there are three main points to be taken into account. Firstly, the researcher should be aware that simple transection of the spinal cord is not a feature of human SCI. The usual lesion is one of compression and disruption with haemorrhage. The second and most important aspect of human SCI is to understand that Wallerian degeneration inevitably ensues following disruption of the axon. Wallerian degeneration is progressive and inexorable and unlike the peripheral nervous system CNS axons do not regenerate. The third and more helpful fact is that in the majority (71%) of SCI autopsies a small amount of white matter, myelin and axons, was found to be preserved at the level of injury. Re-activation of these dormant, axons offers the opportunity for improvement of the SCI patient’s neurological status by means of restorative neurology (RN).

scholarly journals Ongoing Walking Recovery 2 Years After Locomotor Training in a Child With Severe Incomplete Spinal Cord Injury

2010 ◽  
Vol 90 (5) ◽  
pp. 793-802 ◽  
Author(s):  
Emily J. Fox ◽  
Nicole J. Tester ◽  
Chetan P. Phadke ◽  
Preeti M. Nair ◽  
Claudia R. Senesac ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Gait Speed ◽  
Growth And Development ◽  
Locomotor Training ◽  
Daily Step ◽  
Cord Injury ◽  
Age Appropriate ◽  
Walking Recovery ◽  
Leg Movements

Background and Purpose The authors previously reported on walking recovery in a nonambulatory child with chronic, severe, incomplete cervical spinal cord injury (SCI) after 76 sessions of locomotor training (LT). Although clinical measures did not predict his recovery, reciprocal patterned leg movements developed, affording recovery of independent walking with a reverse rolling walker. The long-term functional limitations and secondary complications often associated with pediatric-onset SCI necessitate continued follow-up of children with SCI. Therefore, the purpose of this case report is to describe this child's walking function and musculoskeletal growth and development during the 2 years since his participation in an LT program and subsequent walking recovery. Case Description Following LT, the child attended elementary school as a full-time ambulator. He was evaluated 1 month (baseline), 1 year, and 2 years after LT. Examination of walking function included measures of walking independence, gait speed and spatiotemporal parameters, gait kinematics, and daily step activity. Growth and development were assessed by tracking his height, weight, incidence of musculoskeletal complications, and gross motor task performance. Outcomes Over the 2 years, the child continued to ambulate independently with a reverse rolling walker, increasing his fastest gait speed. Spatiotemporal and kinematic features of his walking improved, and daily step activity increased. Height and weight remained on their preinjury trajectory and within age-appropriate norms. The child experienced only minor musculoskeletal complications. Additionally, he gained the ability to use reciprocal patterned leg movements during locomotor tasks such as assisted stair climbing and independent tricycle pedaling. Conclusions Two years after recovery of walking, this child with incomplete SCI had maintained and improved his walking function and experienced age-appropriate growth and development.

scholarly journals Ten Meters Walking Speed in Spinal Cord–Injured Patients: Does Speed Predict Who Walks and Who Rolls?

2017 ◽  
Vol 31 (9) ◽  
pp. 842-850 ◽  
Author(s):  
Lysanne van Silfhout ◽  
Allard J. F. Hosman ◽  
Ronald H. M. A. Bartels ◽  
Michael J. R. Edwards ◽  
Rainer Abel ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Injury Severity ◽  
Walking Speed ◽  
Locomotor Training ◽  
Operating Characteristics ◽  
Cord Injury ◽  
Community Ambulation ◽  
Key Factor ◽  
Independent Ambulation

Background. Walking speed is assumed to be a key factor in regaining ambulation after spinal cord injury (SCI). However, from the literature it remains unclear which walking speed usually results in independent community ambulation. Objective. The primary aim of this study was to determine at which walking speed SCI patients tend to walk in the community instead of using a wheelchair. The secondary aim was to investigate clinical conditions that favor independent ambulation in the community. Methods. Data from SCI patients were collected retrospectively from the European Multicenter Study about Spinal Cord Injury database. We determined a cutoff walking speed at which the patients tend to walk in the community by plotting a receiver operating characteristics curve, using the Spinal Cord Independence Measure for outdoor mobility. Univariate analyses investigated which factors influence independent community ambulation. Results. A walking speed of 0.59 m/s is the cutoff between patients who do and do not ambulate independently in the community, with a sensitivity of 91.6% and a specificity of 80.3%. Age, injury severity, and lower limb muscle strength have a significant influence on independent community ambulation. Conclusions. Patients with an SCI who regain a walking speed of 0.59 m/s tend to achieve a level of walking effectiveness that allows for independent community walking. Although such patients tend to be younger and less severely injured, this walking speed can be a target for locomotor training in rehabilitation and clinical trials that lead to a meaningful outcome level of community walking.

scholarly journals Locomotor Training Progression and Outcomes After Incomplete Spinal Cord Injury

2005 ◽  
Vol 85 (12) ◽  
pp. 1356-1371 ◽  
Author(s):  
Andrea L Behrman ◽  
Anna R Lawless-Dixon ◽  
Sandra B Davis ◽  
Mark G Bowden ◽  
Preeti Nair ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Walking Ability ◽  
Locomotor Training ◽  
Full Time ◽  
Incomplete Spinal Cord Injury ◽  
Weight Support ◽  
Walking Activity ◽  
Cord Injury

Abstract Background and Purpose. The use of locomotor training with a body-weight–support systemand treadmill (BWST) and manual assistance has increased in rehabilitation. The purpose of this case report isto describe the process for retraining walking in a person with an incomplete spinal cord injury (SCI) using the BWST and transferring skills from the BWST to overground assessment and community ambulation. Case Description. Following discharge from rehabilitation, a man with an incomplete SCI at C5–6 and an American Spinal Injury Association (ASIA) Impairment Scale classification of D participated in 45sessions of locomotor training. Outcomes. Walking speed and independence improved from 0.19 m/s as a home ambulator using a rolling walker and a right ankle-foot orthosis to 1.01 m/s as a full-time ambulator using a cane only for communitymobility. Walking activity (X̄±SD) per 24 hours increased from 1,054±543 steps to 3,924±1,629 steps. Discussion. In a person with an incomplete SCI, walking ability improved after locomotor trainingthat used a decision-making algorithm and progression across training environments.

scholarly journals Sexual dysfunction and rehabilitation of patients with spinal cord injury

2020 ◽  
Vol 63 (10) ◽  
pp. 612-622
Author(s):  
Bum-Suk Lee ◽  
Onyoo Kim
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Erectile Dysfunction ◽  
Spinal Cord Injuries ◽  
Sexual Life ◽  
Full Time ◽  
Sexual Rehabilitation ◽  
Rehabilitation Programs ◽  
Cord Injury ◽  
Intracavernosal Injections

In the rehabilitation of patients with spinal cord injuries, sexual rehabilitation is a pertinent issue that should not be ignored. Although they may not openly discuss sexual issues with their doctor at first, patients consider these issues to be very important. Therefore, doctors should ask their patients about their sexual problems in order to provide them with consultation and treatment. For males with spinal cord injuries, erectile dysfunction is the most significant problem. Patients are looking for a doctor who can help them to solve their problem of erectile dysfunction. Fortunately, there are a variety of effective methods that can help with erectile dysfunction in patients with spinal cord injuries. Oral medications, such as sildenafil, are very effective. However, if medications prove ineffective, intracavernosal injections may be considered. Couples with spinal cord injury are, of course, still capable of sexual intercourse. A couple in which the patient is a male may use the woman-on-top position. If the aim is conception, women with spinal cord injuries should be informed that their fertility is likely unaffected. Doctors may recommend that males with spinal cord injuries be treated in a fertility clinic. Hospitals with full-time sexual rehabilitation personnel and sexual rehabilitation programs can be of great help to patients with spinal cord injuries. The scope of such sexual rehabilitation should include not only medical help but also strategies for restoring sexual life, eliminating conflicts, and ensuring the happiness of couples.

scholarly journals Progress in Understanding Ferroptosis and Its Targeting for Therapeutic Benefits in Traumatic Brain and Spinal Cord Injuries

2021 ◽  
Vol 9 ◽  
Author(s):  
Xinli Hu ◽  
Yu Xu ◽  
Hui Xu ◽  
Chenqiang Jin ◽  
Haojie Zhang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cell Death ◽  
Nervous System ◽  
Spinal Cord Injuries ◽  
Glutathione Metabolism ◽  
Autonomic Nervous System Dysfunction ◽  
Therapeutic Benefits ◽  
Relevant Effect ◽  
Cord Injury ◽  
Cns Trauma

Acute central nervous system (CNS) trauma, including spinal cord injury (SCI) and traumatic brain injury (TBI), always leads to severe sensory, motor and autonomic nervous system dysfunction due to a series of processes, including cell death, oxidative stress, inflammation, and excitotoxicity. In recent years, ferroptosis was reported to be a type of programmed cell death characterized by the consumption of polyunsaturated fatty acids and the accumulation of membrane lipid peroxides. The processes that induce ferroptosis include iron overload, imbalanced glutathione metabolism and lipid peroxidation. Several studies have indicated a novel association of ferroptosis and acute CNS trauma. The present paper reviews recent studies of the occurrence of ferroptosis, stressing the definition and process of ferroptosis and metabolic pathways related to ferroptosis. Furthermore, a summary of the existing knowledge of the role of ferroptosis in CNS trauma is presented. The aim here is to effectively understand the mechanisms underlying the occurrence of ferroptosis, as well as the relevant effect on the pathophysiological process of CNS trauma, to present a novel perspective and frame of reference for subsequent investigations.

scholarly journals Effects of Locomotor Exercise Intensity on Gait Performance in Individuals With Incomplete Spinal Cord Injury

2016 ◽  
Vol 96 (12) ◽  
pp. 1919-1929 ◽  
Author(s):  
Kristan A. Leech ◽  
Catherine R. Kinnaird ◽  
Carey L. Holleran ◽  
Jennifer Kahn ◽  
T. George Hornby
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
High Intensity ◽  
Gait Speed ◽  
Control Group ◽  
Locomotor Training ◽  
Incomplete Spinal Cord Injury ◽  
Short Term ◽  
Gait Performance ◽  
Cord Injury

AbstractBackgroundHigh-intensity stepping practice may be a critical component to improve gait following motor incomplete spinal cord injury (iSCI). However, such practice is discouraged by traditional theories of rehabilitation that suggest high-intensity locomotor exercise degrades gait performance. Accordingly, such training is thought to reinforce abnormal movement patterns, although evidence to support this notion is limited.ObjectiveThe purposes of this study were: (1) to evaluate the effects of short-term manipulations in locomotor intensity on gait performance in people with iSCI and (2) to evaluate potential detrimental effects of high-intensity locomotor training on walking performance.DesignA single-day, repeated-measures, pretraining-posttraining study design was used.MethodsNineteen individuals with chronic iSCI performed a graded-intensity locomotor exercise task with simultaneous collection of lower extremity kinematic and electromyographic data. Measures of interest were compared across intensity levels of 33%, 67%, and 100% of peak gait speed. A subset of 9 individuals participated in 12 weeks of high-intensity locomotor training. Similar measurements were collected and compared between pretraining and posttraining evaluations.ResultsThe results indicate that short-term increases in intensity led to significant improvements in muscle activity, spatiotemporal metrics, and joint excursions, with selected improvements in measures of locomotor coordination. High-intensity locomotor training led to significant increases in peak gait speed (0.64–0.80 m/s), and spatiotemporal and kinematic metrics indicate a trend for improved coordination.LimitationsMeasures of gait performance were assessed during treadmill ambulation and not compared with a control group. Generalizability of these results to overground ambulation is unknown.ConclusionsHigh-intensity locomotor exercise and training does not degrade, but rather improves, locomotor function and quality in individuals with iSCI, which contrasts with traditional theories of motor dysfunction following neurologic injury.

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.

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