scholarly journals Housing for People with an Acquired Brain or Spinal Injury: Mapping the Australian Funding Landscape

2019 ◽  
Vol 16 (16) ◽  
pp. 2822 ◽  
Author(s):  
Wright ◽  
Colley ◽  
Knudsen ◽  
Kendall
Keyword(s):  
Support Services ◽  
Spinal Injury ◽  
Grey Literature ◽  
Acquired Brain Injury ◽  
Evidence Based ◽  
Policy Makers ◽  
Suitable Alternative ◽  
Cord Injury ◽  
Housing Options

This research aimed to synthesize housing supports funded by 20 major insurance-based schemes for Australians with an acquired brain injury (ABI) or spinal cord injury (SCI). Publicly available grey literature (i.e., primary information from respective scheme websites) was systematically reviewed and compared. There were notable differences between the different scheme types (disability vs. workers compensation schemes) and across different States. Collectively, scheme funding was more likely to be focused on housing infrastructure and service delivery, than on tenancy support. Australians who are least likely to benefit from the current funding context are those whose home cannot be reasonably modified, are wanting to build or purchase a new home, do not have suitable, alternative short- or long-term housing options if their current home is not feasible, require support to maintain occupancy of their home or financial assistance to move into a new home, may benefit from case management services, family supports, and assistance animals, and/or cannot afford their rent or home loan repayments. Several interactions, inconsistencies, contradictions, and gaps that warrant further attention were also revealed. This review has highlighted the need for policy makers to provide transparent information about housing entitlements for individuals with ABI or SCI, and their families. A unified, evidence-based framework to guide the funding of housing and housing support services may increase the consistency of interventions available to people with ABI or SCI and, therefore, improve outcomes.

Posttraumatic spinal cord tethering and syringomyelia: surgical treatment and long-term outcome

2009 ◽  
Vol 11 (4) ◽  
pp. 445-460 ◽  
Author(s):  
Scott P. Falci ◽  
Charlotte Indeck ◽  
Daniel P. Lammertse
Keyword(s):  
Spinal Cord ◽  
Spinal Injury ◽  
Treatment Center ◽  
Term Outcome ◽  
Repeat Surgery ◽  
Long Term Outcome ◽  
Progressive Myelopathy ◽  
Cord Injury ◽  
Spinal Cord Tethering

Object Permanent neurological loss after spinal cord injury (SCI) is a well-known phenomenon. There has also been a growing recognition and improved understanding of the pathophysiological mechanisms of late progressive neurological loss, which may occur after SCI as a result of posttraumatic spinal cord tethering (SCT), myelomalacia, and syringomyelia. A clinical study of 404 patients sustaining traumatic SCIs and undergoing surgery to arrest a progressive myelopathy caused by SCT, with or without progressive myelomalacia and cystic cavitation (syringomyelia) was undertaken. Both objective and subjective long-term outcomes were evaluated. To the authors' knowledge, this is the first series of this size correlating long-term patient perception of outcome with long-term objective outcome analyses. Methods During the period from January 1993 to November 2003, 404 patients who had previously sustained traumatic SCIs underwent 468 surgeries for progressive myelopathies attributed to tethering of the spinal cord to the surrounding spinal canal, with or without myelomalacia and syrinx formation. Forty-two patients were excluded because of additional pathological entities that were known to contribute to a progressive myelopathy. All surgeries were performed by the same neurosurgeon at a single SCI treatment center and by using a consistent surgical technique of spinal cord detethering, expansion duraplasty, and when indicated, cyst shunting. Results Outcome data were collected up to 12 years postoperatively. Comparisons of pre- and postoperative American Spinal Injury Association sensory and motor index scores showed no significant change when only a single surgery was required (86% of patients). An outcome questionnaire and phone interview resulted in > 90% of patients self-assessing arrest of functional loss; > 50% of patients self-assessing improvement of function; 17 and 18% self-assessing improvement of motor and sensory functions to a point greater than that achieved at any time postinjury, respectively; 59% reporting improvement of spasticity; and 77% reporting improvement of hyperhidrosis. Conclusions Surgery for spinal cord detethering, expansion duraplasty, and when indicated, cyst shunting, is a successful treatment strategy for arresting a progressive myelopathy related to posttraumatic SCT and syringomyelia. Results suggest that surgery leads to functional return in ~ 50% of patients, and that in some patients posttraumatic SCT limits maximal recovery of spinal cord function postinjury. A patient's perception of surgery's failure to arrest the progressive myelopathy corresponds closely with the need for repeat surgery because of retethering, cyst reexpansion, and pseudomeningocele formation.

scholarly journals Olfactory ensheathing cell transplantation for chronic spinal cord injury: A long-term follow-up study

2021 ◽  
Vol 9 (2) ◽  
pp. 94-105
Author(s):  
Naifeng Kuang ◽  
Xiaoyu Wang ◽  
Yuexia Chen ◽  
Guifeng Liu ◽  
Fan’e Kong ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Autonomic Function ◽  
Spinal Injury ◽  
International Standards ◽  
Olfactory Ensheathing Cell ◽  
Cord Injury ◽  
Long Term Follow Up

Spinal cord injury is a serious disabling condition. Transplantation of olfactory ensheathing cells (OECs) is one of the most promising treatments for spinal cord injury (SCI). Thirty-nine patients with chronic SCI received OEC transplantation and completed long-term follow-up, with a minimum follow-up of 7 years. We assessed sensorimotor function with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) and autonomic nervous function by the International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI), and sympathetic skin responses (SSR). The scores of each group were significantly higher after OECs transplantation than before treatment. SSR latencies were shorter and response amplitudes increased after treatment. Long-term follow-up showed further improvement only in motor function and autonomic function compared with 3 months postoperatively. No complications occurred in any patient during long-term follow-up. The results indicate that the transplantation of OECs in spinal cord restored function without serious side effects.

Long-Term Follow-up of Patients with Spinal Cord Injury

2005 ◽  
Vol 19 (4) ◽  
pp. 332-337 ◽  
Author(s):  
Figen Yilmaz ◽  
Fusun Sahin ◽  
Semra Aktug ◽  
Banu Kuran ◽  
Adem Yilmaz
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
American Spinal Injury Association ◽  
Cord Injury ◽  
Long Term Follow Up

Objective. The aim of this study was to evaluate the motor, sensory, and functional recovery in patients with spinal cord injury (SCI). Methods. Forty-one patients with SCI participated in this study. Twenty patients were evaluated after discharge. Each patient was evaluated by the American Spinal Injury Association (ASIA) impairment scale and the Functional Independence Measure (FIM) at admission, before discharge, and at least at 6 months after discharge. Friedman, Dunn, and Mann-Whitney U tests were used for statistical analysis. Results. There were 17 male and 3 female patients. Seven patients had complete SCI, and 13 patients had incomplete SCI. The evaluation of motor, sensory, and FIM scores at admission showed significant improvement in all of the patients during the follow-up period (P < 0.0001). Five incompletely injured cases improved with regard to ASIA staging. Motor and FIM scores significantly increased at follow-up for converted and unconverted patients. All parameters increased at follow-up in patients who were complete and incomplete. Motor scores significantly increased at discharge and at follow-up. FIM scores also increased significantly at follow-up in incomplete patients. Conclusion. Motor, sensory, and FIM scores increased in patients with SCI after a follow-up period of 18 months. Improvement to a higher ASIA stage could be accomplished by 25% of the patients. Although both complete and incomplete patients recovered significantly at the follow-up period, only incompletely injured cases could convert to a higher ASIA stage.

Long-term outcome of paediatric spinal cord injury

Trauma ◽  
2017 ◽  
Vol 19 (1_suppl) ◽  
pp. 75-82 ◽  
Author(s):  
Richa Kulshrestha ◽  
Naveen Kumar ◽  
J Roy Chowdhury ◽  
Aheed Osman ◽  
W El Masri
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Social Outcomes ◽  
Long Term Outcomes ◽  
Cord Injury ◽  
Post Traumatic ◽  
Clinical Records

Background Spinal cord injuries are relatively uncommon in children and evidence about long-term outcomes is limited. This study was performed to determine the frequency of common long-term complications in patients sustaining spinal injury in childhood (0–18 years) and who were followed up at a single dedicated spinal injuries centre in the UK. Method A retrospective review of clinical records of all patients injured at or less than 18 years of age between 1971 and 1999. Complications studied were renal, bowel, musculoskeletal, pressure ulcers and post-traumatic syringomyelia. Long-term social outcomes of independence, employment and driving were also assessed. Results Of 69 individuals (47 males, 22 females) the median age at injury was 17 years (range 0–18 y); 68% were older than 13 years at injury and 74% had traumatic injuries. Patients had an average duration of 27 years (12–43 years) of spinal injury – half had a neurological level of T6 and above, 80% had paraplegia and 20% had quadriplegia. Discussion Patients with both complete and incomplete spinal cord injury have minimal neurological recovery. Managing medical complications is vital as only 11.5% had normal voiding and 10.6% had normal bowel function. The incidence of skin ulcers increases with duration of spinal cord injury and scoliosis is higher in the non-traumatic injury group. Spasticity is observed in 66.6% and post-traumatic syringomyelia in 11.7%. Long-term social outcomes are good with 75% patients able to do independent care, 46% could drive and 39% managed employment or higher education. Conclusions This study documents the long-term outcomes and complications of spinal cord injuries sustained in childhood. With initial active physiological conservative management of the majority of patients, patient education and ongoing support the majority of patients achieved long-term survival and led independent and productive lives.

scholarly journals Traumatic Spinal Cord Injury: Long-Term Motor, Sensory, and Urinary Outcomes

2017 ◽  
Vol 11 (3) ◽  
pp. 412-418 ◽  
Author(s):  
Rouzbeh Motiei-Langroudi ◽  
Homa Sadeghian
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Treatment Protocol ◽  
Spinal Column ◽  
Surgical Approaches ◽  
Trauma Mechanism ◽  
Cord Injury

<sec><title>Study Design</title><p>Retrospective study.</p></sec><sec><title>Purpose</title><p>To evaluate how motor, sensory, and urinary outcomes of spinal cord injury (SCI) patients were influenced in the long term.</p></sec><sec><title>Overview of Literature</title><p>SCI is a potentially disabling and devastating neurological outcome that can occur because of spinal column fractures. Most studies have not evaluated or have failed to show the influence of different surgical approaches and other parameters on neurological recovery.</p></sec><sec><title>Methods</title><p>A thorough history regarding sensory, motor, and urinary complaints was taken from 103 patients with SCI due to vertebral fracture; patients were followed by a thorough neurological examination. Subsequently, all medical records of patients, including neurological state after trauma, trauma mechanism, treatment protocol, surgical protocol, and imaging findings, were evaluated.</p></sec><sec><title>Results</title><p>Of the 103 patients, 73.8% were survivors of a major earthquake and 26.2% were victims of vehicle accidents; 92.2% patients were surgically treated, while 7.8% underwent conservative management. The mean follow-up duration was 10.3 years. In follow-up visits, 67.0%, 12.6%, 13.6%, and 6.8% patients showed no, partial, substantial, and complete motor improvement, respectively; 68.0%, 26.2%, and 5.8% showed no, mild, and substantial sensory improvement, respectively; and 73.8%, 17.5%, and 8.7% showed no, substantial, and complete urinary improvement, respectively. Logistic regression analysis showed that sex, age at injury time, follow-up duration, trauma mechanism, and stem cell therapy had no effect on motor, sensory, and urinary improvement. Higher initial scores on the American Spinal Injury Association (ASIA) classification, lumbar fracture level, and performance of laminectomy improved motor outcome; higher initial ASIA scores improved urinary and sensory outcomes.</p></sec><sec><title>Conclusions</title><p>The initial ASIA score is the most important factor for prognosticating motor, sensory, and urinary improvement in SCI patients. Lumbar (L3–L5) and thoracic (T1–T10) fractures have the best and worst prognosis, respectively, in terms of motor recovery. Laminectomy during surgery improves motor function.</p></sec>

scholarly journals Correlation of magnetic resonance diffusion tensor imaging parameters with American Spinal Injury Association score for prognostication and long-term outcomes

2019 ◽  
Vol 46 (3) ◽  
pp. E2 ◽  
Author(s):  
Saman Shabani ◽  
Mayank Kaushal ◽  
Matthew Budde ◽  
Shekar N. Kurpad
Keyword(s):  
Correlation Analysis ◽  
Spinal Injury ◽  
Time Of Arrival ◽  
American Spinal Injury Association ◽  
Long Term Outcome ◽  
Imaging Parameters ◽  
Cord Injury ◽  
Asia Score

OBJECTIVEConventional MRI is routinely used to demonstrate the anatomical site of spinal cord injury (SCI). However, quantitative and qualitative imaging parameters have limited use in predicting neurological outcomes. Currently, there are no reliable neuroimaging biomarkers to predict short- and long-term outcome after SCI.METHODSA prospective cohort of 23 patients with SCI (19 with cervical SCI [CSCI] and 4 with thoracic SCI [TSCI]) treated between 2007 and 2014 was included in the study. The American Spinal Injury Association (ASIA) score was determined at the time of arrival and at 1-year follow-up. Only 15 patients (12 with CSCI and 3 with TSCI) had 1-year follow-up. Whole-cord fractional anisotropy (FA) was determined at C1–2, following which C1–2 was divided into upper, middle, and lower segments and the corresponding FA value at each of these segments was calculated. Correlation analysis was performed between FA and ASIA score at time of arrival and 1-year follow-up.RESULTSCorrelation analysis showed a positive but nonsignificant correlation (p = 0.095) between FA and ASIA score for all patients (CSCI and TCSI) at the time of arrival. Additional regression analysis consisting of only patients with CSCI showed a significant correlation (p = 0.008) between FA and ASIA score at time of arrival as well as at 1-year follow-up (p = 0.025). Furthermore, in case of patients with CSCI, a significant correlation between FA value at each of the segments (upper, middle, and lower) of C1–2 and ASIA score at time of arrival was found (p = 0.017, p = 0.015, and p = 0.002, respectively).CONCLUSIONSIn patients with CSCI, the measurement of diffusion anisotropy of the high cervical cord (C1–2) correlates significantly with injury severity and long-term follow-up. However, this correlation is not seen in patients with TSCI. Therefore, FA can be used as an imaging biomarker for evaluating neural injury and monitoring recovery in patients with CSCI.

scholarly journals Structural changes in the landscape of Spanish distance universities

Open Praxis ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 119
Author(s):  
Daniel Domínguez Figaredo ◽  
José Francisco Alvarez Alvarez
Keyword(s):  
Higher Education ◽  
Educational Technology ◽  
Distance Learning ◽  
Structural Changes ◽  
The Internet ◽  
Evidence Based ◽  
Policy Makers ◽  
Methodological Procedures

The main national distance learning universities were launched before the emergence of the Internet. In order to adapt to digital connectivity, these universities had to modify their organizational and methodological procedures. But in recent years important changes have emerged in the field of educational technology, and this has significantly altered the higher education sector.This work analyzed the recent updates that distance-learning universities in Spain have undertaken in order to adapt to the current higher education landscape. The evolution of enrolment rates in distance universities in Spain in the period 2003–2017 was taken as a reference. Based on the available data, the factors that explain the enrolment gap between types of entities are analyzed and key actions for the evolution of distance learning universities in Spain are suggested. This provides an evidence-based approach that aims to contribute to the reflection of academics, institutional managers and policy makers who are called upon to reorient the strategy of distance universities to make them sustainable in the medium and long term in the new landscape.

scholarly journals Unlike Brief Inhibition of Microglia Proliferation after Spinal Cord Injury, Long-Term Treatment Does Not Improve Motor Recovery

2021 ◽  
Vol 11 (12) ◽  
pp. 1643
Author(s):  
Gaëtan Poulen ◽  
Sylvain Bartolami ◽  
Harun N. Noristani ◽  
Florence E. Perrin ◽  
Yannick N. Gerber
Keyword(s):  
Spinal Cord ◽  
Ex Vivo ◽  
Spinal Injury ◽  
Oral Treatment ◽  
Term Treatment ◽  
Motor Recovery ◽  
Beneficial Effects ◽  
Long Term Treatment ◽  
Cord Injury

Microglia are major players in scar formation after an injury to the spinal cord. Microglia proliferation, differentiation, and survival are regulated by the colony-stimulating factor 1 (CSF1). Complete microglia elimination using CSF1 receptor (CSF1R) inhibitors worsens motor function recovery after spinal injury (SCI). Conversely, a 1-week oral treatment with GW2580, a CSF1R inhibitor that only inhibits microglia proliferation, promotes motor recovery. Here, we investigate whether prolonged GW2580 treatment further increases beneficial effects on locomotion after SCI. We thus assessed the effect of a 6-week GW2580 oral treatment after lateral hemisection of the spinal cord on functional recovery and its outcome on tissue and cellular responses in adult mice. Long-term depletion of microglia proliferation after SCI failed to improve motor recovery and had no effect on tissue reorganization, as revealed by ex vivo diffusion-weighted magnetic resonance imaging. Six weeks after SCI, GW2580 treatment decreased microglial reactivity and increased astrocytic reactivity. We thus demonstrate that increasing the duration of GW2580 treatment is not beneficial for motor recovery after SCI.

scholarly journals Magnetic Resonance Imaging Evidence of Therapeutic Efficacy of Timing of Decompression in American Spinal Injury Association Impairment Scale Grades A to C Cervical Spinal Cord Injury Patients

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Joshua R Olexa ◽  
Bizhan Aarabi ◽  
Kathirkamanathan Shanmuganathan ◽  
Noori Akhtardanesh ◽  
Charles A Sansur ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neurological Outcome ◽  
Spinal Injury ◽  
Cervical Spinal Cord ◽  
American Spinal Injury Association ◽  
Resonance Imaging ◽  
Motor Score ◽  
Cord Injury ◽  
Ct And Mri

Abstract INTRODUCTION In traumatic cervical spinal cord injury (SCI), the therapeutic effect of surgery and its timing as neuroprotective measures remain uncertain. Additionally, the relationship between timing of decompression, extent of decompression, imaging biomarkers evidence of injury severity, and outcome are incompletely understood. METHODS We investigated the effect of timing of decompression and long-term neurological outcome in patients with postoperatively confirmed decompression using computed tomography (CT) and magnetic resonance imaging (MRI) studies. A total of 6 mo after cervical SCI, American Spinal Injury Association Impairment Scale (AIS) grade conversion was determined in 72 AIS grades A, B, and C patients whose postoperative CT and MRI confirmed spinal cord decompression. A total of 32 patients underwent decompressive surgery less than 12 hr from injury, 25 within 12 to 24 hr, and 15 more than 24 hr after trauma. RESULTS Age, gender, injury mechanism, intramedullary lesion length (IMLL) on MRI, admission American Spinal Injury Association (ASIA) motor score, and surgical technique were not statistically different in-between groups. Motor complete patients (P = .009) and those with fracture dislocations (P = .01) tended to be operated earlier. One or more grade improvement was 55.6% in AIS grade A, 60.9% in AIS grade B, and 86.4% in AIS grade C patients. Admission AIS motor score (P = .0004) and preoperative IMLL (P = 0001) were the strongest predictors of neurological outcome. AIS grade improvement was 65.6% in patients undergoing decompressive surgery within 12 hr after trauma, 60% in patients undergoing surgery within 12 to 24 hr, and 80% when decompression was performed more than 24 hr after injury (P = .424). Multiple regression analysis of all significant and marginally significant variables revealed that the only significant variable predictive of AIS grade conversion to a better grade was IMLL (odds ratio 133.51, CI 11.68-1525.71, P < .0001). CONCLUSION In patients with postoperative CT and MRI confirmation of decompression following traumatic cervical SCI, preoperative IMLL and not the timing of surgery appears to determine long-term neurological outcome.

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