scholarly journals A comparison of paraplegic gait performance using two types of reciprocating gait orthoses

1993 ◽  
Vol 17 (2) ◽  
pp. 101-106 ◽  
Author(s):  
P. K. Winchester ◽  
J. J. Carollo ◽  
R. N. Parekh ◽  
L. M. Lutz ◽  
J. W. Aston
Keyword(s):  
Spinal Cord ◽  
Respiratory Exchange Ratio ◽  
Energy Costs ◽  
Orthotic Devices ◽  
Cost Index ◽  
Gait Performance ◽  
Significant Difference ◽  
Cord Injury ◽  
The Difference ◽  
Spinal Cord Injured

This study examined the energy cost of ambulation using the reciprocating gait orthosis (RGO) and the modified Isocentric RGO in paraplegic spinal cord injured subjects. In 4 subjects, the rates of O2 consumption per minute, O2 cost per metre, heart rate (HR), respiratory exchange ratio, velocity, and physiologic cost index (PCI) were measured during ambulation with the two orthotic devices. PCI was calculated by dividing the difference between walking and resting HR by velocity. PCI was significantly lower during ambulation trials with the Isocentric RGO compared to the RGO, but was the only measurement that detected a significant difference beween the two orthotic devices. These results indicate that energy costs of ambulation at self-selected speeds were lower with the Isocentric RGO compared to the standard RGO. Furthermore, PCI could be used as a sensitive indicator of gait efficiency in spinal cord injury subjects.

scholarly journals The effectiveness and safety of LMWH for preventing thrombosis in patients with spinal cord injury: a meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ze Lin ◽  
Yun Sun ◽  
Hang Xue ◽  
Lang Chen ◽  
Chenchen Yan ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Venous Thrombosis ◽  
Meta Analysis ◽  
Therapeutic Effects ◽  
Significant Difference ◽  
Cord Injury ◽  
Review Manager ◽  
Evident Difference

Abstract Background Unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are commonly used for preventing venous thrombosis of the lower extremity in patients with traumatic spinal cord injury. Although, LMWH is the most commonly used drug, it has yet to be established whether it is more effective and safer than UFH. Further, a comparison of the effectiveness of LMWH in preventing thrombosis at different locations and different degrees of spinal cord injury has also not been clearly defined. Materials and methods Cohort studies comparing the use of LMWH and UFH in the prevention of lower limb venous thrombosis in patients with spinal cord injury were identified using PubMed. The risk of bias and clinical relevance of the included studies were assessed using forest plots. The Newcastle-Ottawa quality assessment scale was used to evaluate the quality of the included studies. The main results of the study were analyzed using Review Manager 5.3. Results A total of five studies were included in this meta-analysis. Four studies compared the effectiveness and safety of LMWH and UFH in preventing thrombosis in patients with spinal cord injury. No significant differences were found between the therapeutic effects of the two drugs, and the summary RR was 1.33 (95% CI 0.42–4.16; P = 0.63). There was also no significant difference in the risk of bleeding between the two medications, and the aggregate RR was 0.78 (95% CI 0.55–1.12; P = 0.18). When comparing the efficacy of LMWH in preventing thrombosis in different segments and different degrees of spinal cord injury, no significant differences were found. Conclusions The results of this analysis show that compared with UFH, LMWH has no obvious advantages in efficacy nor risk prevention, and there is no evident difference in the prevention of thrombosis for patients with injuries at different spinal cord segments.

MSC secreted extracellular vesicles carrying TGF-beta upregulate Smad 6 expression and promote the regrowth of neurons in spinal cord injured rats

2021 ◽  
Author(s):  
Tianyu Han ◽  
Peiwen Song ◽  
Zuomeng Wu ◽  
Xiang Xia ◽  
Ying Wang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Stem Cells ◽  
Extracellular Vesicles ◽  
Kinase Inhibitor ◽  
Inflammatory Factors ◽  
Type I ◽  
Post Injury ◽  
Cord Injury ◽  
Spinal Cord Injured ◽  
Feedback Regulator

Abstract Mesenchymal stem cells (MSCs) are a promising therapy for spinal cord injury (SCI) as they can provide a favorable environment for the regrowth of neurons and axons by inhibiting receptor-regulated Smads (R-Smads) in endogenous neural stem cells (NSCs). However, their mechanism of action and effect on the expression of inhibitory Smads (I-Smads) remains unclear. Here, we demonstrated that Extracellular vesicles (EVs) from MSCs were able to upregulate the Smad 6 expression by carrying TGF-β. Smad 6 knockdown in NSCs partly weakened the BMSC-EVs-induced effect on neural differentiation. In spinal cord injured rats, we found that in the acute phase of injury, the Smad 6 expression was not reduced by the treatment of TGF-β type I receptor kinase inhibitor SB431542, indicating that the Smad 6 expression was not only mediated TGF-β, the inflammatory factors and BMPs were also involved. However, in the later phase of SCI, the Smad 6 expression was reduced by the addition of SB 431542, suggesting in this phase, TGF-β played a key role on the mediation of Smad 6 expression. In addition, by immunohistochemistry staining, Hematoxylin-eosin staining and BBB scores, we revealed that the early inhibition of TGF-β did not increase the regrowth of neurons. Instead, it increased the volume of cavity and the Caspase-3 expression at 24h post-injury, leading to a wore functional outcome. In contrast the later treatment of the TGF-β inhibitor promoted the regrowth of neurons around the cavity, resulting into a better neurological outcome. Together all these results indicated that Smad 6 acts as a feedback regulator to prevents over-differentiation of NSCs to astrocytes and BMSC-EVs can upregulate Smad 6 expression by the carring TGF-β.

The Effect of Acceptance and Commitment Therapy on Psychological Flexibility and Emotional Regulation in Patients with Spinal Cord Injuries: A Randomized Controlled Trial

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Mohammad Saeed Khanjani ◽  
Javad Kazemi ◽  
Jalal Younesi ◽  
Asghar Dadkhah ◽  
Akbar Biglarian ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Emotion Regulation ◽  
Emotional Regulation ◽  
Spinal Cord Injuries ◽  
Psychological Flexibility ◽  
Control Group ◽  
Acceptance And Commitment ◽  
Significant Difference ◽  
Cord Injury ◽  
And Control

Background: Patients with spinal cord injuries suffer from some psychological problems, such as inadequate emotional regulation and flexibility for adapting to the post-injury condition. In this regard, acceptance and commitment therapy (ACT) can improve psychological flexibility and emotional regulation. Objectives: The main goal of this study was to analyze the effectiveness of ACT in improving psychological flexibility and emotional regulation in patients with spinal cord injuries. Methods: This quasi-experimental design study was based on a pretest-posttest method with a control group. The study population consisted of all patients with spinal cord injury referred to Jalaeipour Rehabilitation Center in Tehran. The study sample included 30 patients with spinal cord injury selected by the purposive sampling method. The inclusion criteria were patients aged 20 to 55 years, residing in Tehran, and with at least a high school diploma. The injury duration varied between one and five years, and the injuries were thoracic and lumbar injuries and an intermediate score of psychological flexibility and emotion regulation. The exclusion criteria were patients with cervical spinal cord injuries, as well as patients who were simultaneously receiving another psychological treatment together with the subjects who suffered from brain damage. Patients were randomly assigned to the experimental and control groups based on random numbers. There were 15 patients in each group. The intervention group received ACT during eight sessions (1.5-hour group therapy) held once a week at Jalaeipour Rehabilitation Center in Tehran (2018), while the control group received routine care. Dennis and Vander Wal’s cognitive flexibility inventory (CFI) and Gross and John’s emotion regulation questionnaire (ERQ) were completed before and one week after the intervention. The data were analyzed using multivariate analysis of covariance (MANCOVA). Results: There was a significant difference in demographic indicators between the two groups. Based on MANCOVA with the baseline score, the mean scores of psychological flexibility and emotion regulation had a significant difference regarding the results of ACT between the experimental and control groups (P < 0.05). Conclusions: According to the findings, ACT can improve psychological flexibility and emotional regulation in patients with spinal cord injuries.

The therapeutic window for spinal cord decompression in a rat spinal cord injury model

2005 ◽  
Vol 3 (4) ◽  
pp. 302-307 ◽  
Author(s):  
Christopher B. Shields ◽  
Y. Ping Zhang ◽  
Lisa B. E. Shields ◽  
Yingchun Han ◽  
Darlene A. Burke ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Stenosis ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Therapeutic Window ◽  
Content Type ◽  
Significant Difference ◽  
Cord Injury ◽  
Fine Print

Object. There are no clinically based guidelines to direct the spine surgeon as to the proper timing to undertake decompression after spinal cord injury (SCI) in patients with concomitant stenosis-induced cord compression. The following three factors affect the prognosis: 1) severity of SCI; 2) degree of extrinsic spinal cord compression; and 3) duration of spinal cord compression. Methods. To elucidate further the relationship between varying degrees of spinal stenosis and a mild contusion-induced SCI (6.25 g-cm), a rat SCI/stenosis model was developed in which 1.13- and 1.24-mm-thick spacers were placed at T-10 to create 38 and 43% spinal stenosis, respectively. Spinal cord damage was observed after the stenosis—SCI that was directly proportional to the duration of spinal cord compression. The therapeutic window prior to decompression was 6 and 12 hours in the 43 and 38% stenosis—SCI lesions, respectively, to maintain locomotor activity. A significant difference in total lesion volume was observed between the 2-hour and the delayed time(s) to decompression (38% stenosis—SCI, 12 and 24 hours, p < 0.05; 43% stenosis—SCI, 24 hours, p < 0.05) indicating a more favorable neurological outcome when earlier decompression is undertaken. This finding was further supported by the animal's ability to support weight when decompression was performed by 6 or 12 hours compared with 24 hours after SCI. Conclusions. Analysis of the findings in this study suggests that early decompression in the rat improves locomotor function. Prolongation of the time to decompression may result in irreversible damage that prevents locomotor recovery.

Cervical Spinal Cord Injury Shows Markedly Lower than Predicted Mortality (>72 Hours After Multiple Trauma) From Sepsis and Multiple Organ Failure

2018 ◽  
Vol 35 (4) ◽  
pp. 378-382
Author(s):  
Oliver Kamp ◽  
Oliver Jansen ◽  
Rolf Lefering ◽  
Renate Meindl ◽  
Christian Waydhas ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Multiple Organ Failure ◽  
Organ Failure ◽  
Multiple Trauma ◽  
Injury Severity ◽  
Multiple Organ ◽  
Injury Pattern ◽  
Significant Difference ◽  
Cord Injury

Background: Sepsis and multiple organ failure (MOF) remain one of the main causes of death after multiple trauma. Trauma- and infection-associated immune reactions play an important role in the pathomechanism of MOF, but the exact pathways remain unknown. Spinal cord injury (SCI) may lead to an altered immune response, and some studies suggest a prognostic advantage for such patients having sepsis or multiple trauma. Yet these findings need to be evaluated in larger cohorts of trauma patients. Methods: Retrospective, multicenter study, using the data of the TraumaRegister DGU. Patients with and without SCI surviving the initial first 72 hours after trauma were matched according to injury pattern and age. Comparative analysis considered morbidity (sepsis, MOF) and hospital mortality. Results: The study population included 800 matched pairs. As intended by the matching process, patients with cervical SCI had an otherwise comparable injury pattern but a higher severity of trauma (mean Injury Severity Score: 36 vs 29, mean number of diagnosis: 5.6 vs 4.4). They had a higher rate of sepsis (15.9% vs 10.9%, P = .005) and MOF (35.9% vs 24.1%, P < .001) while mortality revealed no significant difference (9.5% vs 9.9%, P = .866). Conclusions: Cervical SCI leads to an increased rate of sepsis and MOF but appears to be favorable with respect to outcome of sepsis and MOF following multiple trauma. Further research should focus on the pathomechanisms and the possible arising therapeutic options.

GAIT DIVISION OF HEALTHY AND SPINAL CORD–INJUREDRHESUS MONKEYSBY ONE-DIMENSIONAL TOE SIGNALS

2018 ◽  
Vol 18 (02) ◽  
pp. 1850017 ◽  
Author(s):  
W. ZHAO ◽  
W. SONG ◽  
J. S. RAO ◽  
R. H. WEI ◽  
L. F. LI ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Human Locomotion ◽  
Function Evaluation ◽  
Evaluation Standards ◽  
Gait Parameters ◽  
Cord Injury ◽  
Analysis Calculation ◽  
Mixed Groups ◽  
Spinal Cord Injured ◽  
Treadmill Belt

Spinal cord injury (SCI) may cause disastrous damage to human locomotion and ultimately make patients suffer from gait anomaly. In the extensive SCI research, the locomotion function serves as a vital standard not only for revealing the underlying SCI mechanism but also for evaluating the clinical therapy. Gait division is the basis of gait analysis. Calculation of gait parameters is available for locomotion function evaluation only when gait cycles are accurately divided. Based on the characteristics of stride height, which is defined as the real-time height of toes vertical to the running direction of a treadmill belt, this study presented three automatic gait division methods, divided the gait cycles for healthy and spinal cord-injured rhesus monkeys, established the evaluation standards, and made comparison of these three methods. For the healthy, injured and mixed groups, the overall accuracies of these three methods were respectively 0.871[Formula: see text][Formula: see text][Formula: see text]0.223, 0.570[Formula: see text][Formula: see text][Formula: see text]0.372, and 0.720[Formula: see text][Formula: see text][Formula: see text]0.339 (method 1); 0.658[Formula: see text][Formula: see text][Formula: see text]0.245, 0.737[Formula: see text][Formula: see text][Formula: see text]0.206, and 0.698[Formula: see text][Formula: see text][Formula: see text]0.228 (method 2); 0.966[Formula: see text][Formula: see text][Formula: see text]0.060, 0.759[Formula: see text][Formula: see text][Formula: see text]0.343, and 0.863[Formula: see text][Formula: see text][Formula: see text]0.265 (method 3). The results show that the stride height characteristics combined with the filter technique may help realize the adequate gait division.

The effect of the perfluorocarbon emulsion OxycyteTM in an ovine model of severe decompression illness

2021 ◽  
pp. 25-31
Author(s):  
William A. Cronin ◽  
◽  
Kiel Khan ◽  
Aaron A. Hall ◽  
Michael Bodo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surface Pressure ◽  
Spinal Cord Lesion ◽  
Saline Control ◽  
Large Animal ◽  
Ovine Model ◽  
Lesion Area ◽  
Significant Difference ◽  
Cord Injury ◽  
Cord Lesion

Background: The treatment of decompression sickness (DCS) with hyperbaric oxygen (HBO2) serves to decrease intravascular bubble size, increase oxygen (O2) delivery to tissue and enhance the elimination of inert gas. Emulsified perfluorocarbons (PFC) combined with breathing O2 have been shown to have similar effects animal models. We studied an ovine model of severe DCS treated with the intravenous PFC OxycyteTM while breathing O2 compared to saline control also breathing O2. Methods: Juvenile male sheep (N=67; weight 24.4+/2.10kg) were compressed to 257 feet of sea water (fsw) in our multiple large-animal chamber where they remained under pressure for 31 minutes. Animals then were decompressed to surface pressure and randomized to receive either Oxycyte at 5mL/kg intravenously (IV) or 5mL/kg saline IV (both receiving 100% O2) 10 minutes after reaching surface pressure. Mortality was recorded at two hours, four hours, and 24 hours after receiving the study drug. Surviving animals underwent perfusion fixation and harvesting of the spinal cord at 24 hours. Spinal cord sections were assessed for volume of lesion area and compared. Results: There was no significant difference in survival at two hours (p=0.2737), four hours (p=0.2101), or 24 hours (p=0.3171). Paralysis at 24 hours was not significantly different. However, spinal cord lesion area was significantly smaller in the Oxycyte group as compared to the saline group, with median spinal cord lesion areas 0.65% vs. 0.94% (p=0.0107). Conclusions: In this ovine model of severe DCS the intravenous PFC Oxycyte did not reduce mortality but did ameliorate spinal cord injury when used after the onset of DCS.

The management of fertility in spinal cord injury

2017 ◽  
Author(s):  
Mikkel Fode ◽  
Jens Sønksen
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Semen Quality ◽  
Sperm Quality ◽  
Sperm Count ◽  
Autonomic Nerve ◽  
Sperm Retrieval ◽  
Cord Injury ◽  
The Right ◽  
Spinal Cord Injured

While spinal cord injury (SCI) does not affect female fertility, the condition most often results in infertility in males due to anejaculation and reduced semen quality. Anejaculation is caused by disruption of the autonomic nerve fibres, which are normally responsible for the ejaculation. The reason for the poor sperm quality has not been firmly established. If spinal cord injured men cannot ejaculate by sexual intercourse or masturbation, ejaculation can be induced by either penile vibratory stimulation or electroejaculation. Only if these methods fail should surgical sperm retrieval be considered. The method of insemination depends largely on the total motile sperm count and patient preference. With the right treatment, it is possible for most SCI men to have children.

scholarly journals Psychiatric aspects of spinal cord injury

1986 ◽  
Vol 42 (4) ◽  
pp. 113-114
Author(s):  
A. J. Lasich
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Emotional Reactions ◽  
Cord Injury ◽  
Injured Patients ◽  
Spinal Cord Injured

The nature of behavioural and emotional reactions displayed by persons with spinal cord injury are described and the value of psychiatric involvement in the routine management is discussed. The importance of emotional care of spinal cord injured patients is emphasized with reference to certain general principles. The psychiatrist should be accessible to both staff and patients for ventilation of feelings. 

scholarly journals Epidemiolgy of spinal cord injury after acute odontoid fractures

2000 ◽  
Vol 8 (6) ◽  
pp. 1-4 ◽  
Author(s):  
James S. Harrop ◽  
Ashwini D. Sharan ◽  
Gregory J. Przybylski
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Consecutive Series ◽  
Cervical Canal ◽  
Associated Injuries ◽  
Odontoid Fractures ◽  
Cord Injury ◽  
Injured Patients ◽  
Spinal Cord Injured

Object Cervical spinal cord injury (SCI) after odontoid fracture is unusual. To identify predisposing factors, the authors evaluated a consecutive series of patients who sustained SCI from odontoid fractures. Methods A consecutive series of 5096 admissions to the Delaware Valley Regional Spinal Cord Injury Center were reviewed, and 126 patients with neurological impairment at the C1–3 levels were identified. Seventeen patients had acute closed odontoid fractures with neurological deficit. Various parameters including demographics, mechanisms of injury, associated injuries, fracture types/displacements, and radiographic cervical canal dimensions were compared between “complete” and “incomplete” spinal cord injured–patients as well as with neurologically intact patients who had suffered odontoid fractures. There were similar demographics, mechanisms of injury, associated injuries, fracture type/displacement, and canal dimensions in patients with complete and incomplete SCIs. However, only patients with complete injury were ventilator dependent. In comparison with patients with intact spinal cords, spinal cord–injured patients were more commonly males (p = 0.011) who had sustained higher velocity injuries (p = 0.027). The computerized tomography scans of 11 of 17 neurologically impaired patients were compared with those of a random sample of 11 patients with intact spinal cords. Although the anteroposterior diameter (p = 0.028) and cross-sectional area (p = 0.0004) of the cervical spinal canal at the C–2 level were smaller in impaired patients, the displacement of the fragment was not different. Conclusions Odontoid fractures are an infrequent cause of SCI. Patients with these injuries typically are males who have smaller spinal canals and have sustained high velocity injuries.

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