Effects of Four-Week Rehabilitation Program on Hemostasis Disorders in Patients with Spinal Cord Injury

Patients with spinal cord injury (SCI) are at an increased risk of deep vein thrombosis (DVT). This study aims at assessing usefulness of D-dimer and compressive Doppler ultrasonography (CDUS) for detecting DVT in patients undergoing rehabilitation at various time-points post-SCI. One-hundred forty-five patients were divided into three groups based on time elapsed since SCI: I (≥3 weeks to 3 months), II (≥3 to 6 months), and III (≥6 months). On admission, D-dimer plasma level measurement and CDUS of the lower limbs venous system were performed. DVT was diagnosed using CDUS in 15 patients (10.3% of entire group), more frequently in group I (22.2% of group) and II (11.7%) compared to group III (1.5%). Most DVT patients received thromboprophylaxis (80%) and were asymptomatic or mildly symptomatic (60%). Median D-dimer was elevated in patients with DVT from all groups, and also patients without DVT from groups I and II, but not group III. D-dimers were higher in patients with DVT than without DVT in the entire group (p = 0.001) and group I (p = 0.02), but not in groups II and III. The risk of DVT in SCI patients undergoing rehabilitation and thromboprophylaxis including asymptomatic or mildly symptomatic cases, is high within 6 months post-injury, and especially within 3 months. Measurement of D-dimer level should be complemented by routine CDUS for detecting DVT within 6 months post-SCI. Over 6 months, the usefulness of D-dimer screening alone is better for DVT detection.

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Functional Outcome in Cats with Acute Severe Injuries of the Thoracolumbar Spinal Cord Following Intensive Rehabilitative Physiotherapy

10.21203/rs.3.rs-47933/v1 ◽

2020 ◽

Author(s):

Antonella Gallucci ◽

Ludovica Dragone ◽

Tania Al Kafaji ◽

Marika Menchetti ◽

Sara Del Magno ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Field Condition ◽

Pain Perception ◽

Rehabilitation Program ◽

Control Group ◽

Severe Injuries ◽

Cord Injury ◽

Pelvic Limb ◽

Intensive Rehabilitation

Abstract Background: literature is lacking data concerning the prognosis in cat suffering from acute thoracolumbar spinal cord lesions on field condition either with or without physiotherapy treatment. We investigated the role of intensive physical rehabilitation training in cats suffering from acute thoracolumbar (TL) spinal cord injury and compared their outcome to the presence/absence of pelvic limb pain perception (PP) under field conditions. A further aim was the evaluation of the outcome of cats under intensive physiotherapy when compared to a control group.Methods: Retrospective study. The medical records of 29 feline patients with acute TL spinal cord injury, with and without PP, selected for intensive rehabilitation treatment were reviewed. Those cats that satisfied the same criteria, but performed at home physiotherapy exercises with the owner, were enrolled as control group.Results: 7 cats had pelvic limb PP, which resulted significantly associated with functional recovery of voluntary locomotion (p=0.01) and voluntary micturition (p= 0.00006). Twenty-two cats (76%) had the absence of pelvic limb PP and the acquisition of spinal walking (SW) was achieved in ten cats (45%). None of these patients regained a voluntary micturition at the end of the treatment. The presence of the crossed extensor reflex on admission was significantly associated with the acquisition of SW (p= 0.008). At 15 days, improvement in assisted walking/UWTM was found to be significantly associated with higher possibility to achieve SW at the end of the treatment (p=0.04). The control group included seven cats. None of the cats had regained voluntary micturition or ambulatory condition. Comparing to the control group, the intensive rehabilitation program was significantly associated with a higher possibility to regain functional locomotion (p= 0.005). Recovery of voluntary micturition did not show significant differences among the control group and the cats that underwent physical therapy.Conclusions: cats with severe acute TL lesion recovery can benefit from physiotherapy and, also in case of loss of PP, the acquisition of SW is possible under field condition.

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Research on neurorehabilitation results in vertebro-medullary post-traumatic conditions associating fractures, in a politramatic context

Balneo Research Journal ◽

10.12680/balneo.2019.300 ◽

2019 ◽

Vol 10 (Vol 10 No. 4) ◽

pp. 555-558

Author(s):

Cristina Octaviana DAIA ◽

Alina-Elena GHERGHICEANU ◽

Elena IVAN ◽

Ioana CAZACU ◽

Ștefana CROITORU ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Rehabilitation Program ◽

The Body ◽

Control Group ◽

Study Group ◽

Vital Functions ◽

Functional Benefit ◽

Cord Injury ◽

Life Threatening

Introduction Polytrauma is considered to be an array of traumatic injuries, of which at least one is directly life-threatening. In another deffinition, polytrauma refers to the existence of two or more organ and / or system impairments, one of which is life-threatening, leading to physical, cognitive, psychological, psychosocial and consecutive functional disabilities, all requiring a complex and long-lasting rehabilitation program. The essential condition for polytrauma is the existence of a severe damage that involves one of the vital functions of the body. The first aim of this paper is to evidence the functional benefit of the specific rehabilitation program of patients with polytrauma, mainly associated with spinal cord injury (SCI) and other fractures. Materials and method. We performed a retrospective analysis of 68 patients having their consent and The Theaching Emergency Hospital “Bagdasar-Arseni” ethics Committee approval, N.O. 684/21.02.2019. Patients were admitted to the Neuro-Muscular Rehabilitation Clinic Division, between October 2017 and May 2019 between the ages of 19 and 79, divided into two lots of 34 patients: the study group, composed by patients with SCI and associated fractures and the control group composed by patients who had only SCI. Results. The level of severity is much higher in the study group, which includes AIS A patients (38%) and AIS C (29%), than the control group composed mostly by incomplete patients - AIS D (41%) and C (26%). The FIM average at admission and discharge is statistically significantly lower in the study group compared with the control group both at admission (25.05 versus 42.29; p = 0.001) and at discharge (38.47 vs. 55.55; P = 0.009). Conclusions. Spinal cord injury in combination with multiple fractures is a negative functioning prognostic factor, both before and after the rehabilitation program. Key words: Polytrauma, spinal cord injury (SCI), rehabilitation program,

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Nimodipine alleviates apoptosis-mediated impairments through the mitochondrial pathway after spinal cord injury

Current Zoology ◽

10.1093/czoolo/57.3.340 ◽

2011 ◽

Vol 57 (3) ◽

pp. 340-349 ◽

Cited By ~ 7

Author(s):

Yafei Cai ◽

Rui Fan ◽

Tianmiao Hua ◽

Huiling Liu ◽

Jing Li

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Caspase 3 ◽

Treated Group ◽

Mitochondrial Pathway ◽

Calcium Flux ◽

Control Group ◽

Cord Injury ◽

Before And After ◽

Apoptosis Detection

Abstract Spinal cord injury (SCI) remains an unsolved human health challenge. To alleviate the impairments of SCI, we studied the therapeutic effect of nimodipine (an L-type Ca2+ channel antagonist) on functional recovery from SCI using Nystrom’s method in a mouse model. Eighty-four mice were divided into three groups: control group in which only vertebral plates were cut off without causing any spinal injuries; SCI; and SCI with nimodipine treatment. We assessed the histopathology, apoptosis detection, cell cycle, mitochondrial transmembrane potential, bcl-2/bax and caspase-3 levels of tissue 8 h, 1 d, 3 d and 4 d after trauma to evaluate rehabilitation. Behavioral performances were also assessed before and after nimodipine treatment. Results from inclined plane tests, motor score assessment and histological observations indicated that mice in the nimodipine-treated group rehabilitated better than those in the SCI group. The ratio of apoptosis, caspase-3 and bax expression in the nimodipine-treated group were significantly lower than those in the SCI group. The mitochondrial membrane potential and bcl-2 expression were up-regulated in the nimodipine-treated group. Taken together, our results indicate that the inhibition of calcium flux by nimodipine could reduce apoptosis processes and tissue damage through a mitochondrial pathway after spinal cord trauma.

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The effect of stretching exercises as part of the rehabilitation program for patients with spinal cord injury

Balneo Research Journal ◽

10.12680/balneo.2019.282 ◽

2019 ◽

Vol 10 (Vol 10 No. 4) ◽

pp. 462-465

Author(s):

Dorin-Alexandru MUREȘAN ◽

Alexandra PIELMUSI ◽

Lăcrămioara PERJU DUMBRAVĂ ◽

Dana Marieta FODOR

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Case Control Study ◽

Rehabilitation Program ◽

Control Group ◽

Non Invasive ◽

Physiotherapy Program ◽

Cord Injury ◽

Control Study ◽

Stretching Exercises

Introduction & objectives: Spinal cord injury is a neurological condition with a devastating impact on all aspects of patients’ life. Spasticity, a symptom of the resulting pyramidal syndrome, can be both beneficial and non-beneficial, and requires treatment when it causes significant limitations and complications. The therapeutic approach comprises a wide variety of therapies ranging from non-invasive to invasive procedures. One of the non-invasive procedures is physiotherapy including stretching exercises. There are several studies investigating the effects of stretching on spasticity but with inconclusive results, slightly favoring a positive effect. The aim of this case-control study was to evaluate the effect of a stretching module added to the specific physiotherapy program for patients with SCI. Material and method: An observational case-control study was conducted which included 20 patients with SCI attending a motor neurorehabilitation program for 10 consecutive days at the Rehabilitation Hospital Cluj-Napoca and “Dorina Palace” Center, Cluj-Napoca, during the years 2016-2017. The patients were divided into 2 groups of 10 patients each: the control group, which received specific physiotherapy and occupational therapy, and the study group, in which a stretching exercise module was added to the rehabilitation program (attended by the control group). The patients were assessed using the Modified Ashworth Scale, the Range of Motion (ROM) test for the lower limb joints, and the Ten Meter Walk Test, both at the beginning and at the end of the 10-days rehabilitation program. Results & discussions: The patients in the study group had statistically significant improvements in all the assessed scores compared to the control group, in which improvements were also present, but at the limit of statistical significance. Conclusion: The inclusion of stretching exercises in the specific physiotherapy program for patients with spastic paraparesis after spinal cord injury seems to have a short-term favorable impact, by reducing spasticity and improving ambulation. Key words: spinal cord injury, spasticity, stretching,

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Functional outcome in cats with acute severe injuries of the thoracolumbar spinal cord following intensive rehabilitative physiotherapy

10.21203/rs.3.rs-47933/v2 ◽

2020 ◽

Author(s):

Antonella Gallucci ◽

Ludovica Dragone ◽

Tania Al Kafaji ◽

Marika Menchetti ◽

Sara Del Magno ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Field Condition ◽

Pain Perception ◽

Rehabilitation Program ◽

Control Group ◽

Severe Injuries ◽

Cord Injury ◽

Pelvic Limb ◽

Intensive Rehabilitation

Abstract Background: literature is lacking data concerning the prognosis in cat suffering from acute thoracolumbar spinal cord lesions on field condition either with or without physiotherapy treatment. We investigated the role of intensive physical rehabilitation training in cats suffering from acute thoracolumbar (TL) spinal cord injury and compared their outcome to the presence/absence of pelvic limb pain perception (PP) under field conditions. A further aim was the evaluation of the outcome of cats under intensive physiotherapy when compared to a control group.Methods: Retrospective study. The medical records of 29 feline patients with acute TL spinal cord injury, with and without PP, selected for intensive rehabilitation treatment were reviewed. Those cats that satisfied the same criteria, but performed at home physiotherapy exercises with the owner, were enrolled as control group.Results: 7 cats had pelvic limb PP, which resulted significantly associated with functional recovery of voluntary locomotion (p=0.01) and voluntary micturition (p= 0.00006). Twenty-two cats (76%) had the absence of pelvic limb PP and the acquisition of spinal walking (SW) was achieved in ten cats (45%). None of these patients regained a voluntary micturition at the end of the treatment. The presence of the crossed extensor reflex on admission was significantly associated with the acquisition of SW (p= 0.008). At 15 days, improvement in assisted walking/UWTM was found to be significantly associated with higher possibility to achieve SW at the end of the treatment (p=0.04). The control group included seven cats. None of the cats had regained voluntary micturition or ambulatory condition. Comparing to the control group, the intensive rehabilitation program was significantly associated with a higher possibility to regain functional locomotion (p= 0.005). Recovery of voluntary micturition did not show significant differences among the control group and the cats that underwent physical therapy.Conclusions: cats with severe acute TL lesion recovery can benefit from physiotherapy and, also in case of loss of PP, the acquisition of SW is possible under field condition.

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Exercise Ameliorates Spinal Cord Injury by Changing DNA Methylation

Cells ◽

10.3390/cells10010143 ◽

2021 ◽

Vol 10 (1) ◽

pp. 143

Author(s):

Ganchimeg Davaa ◽

Jin Young Hong ◽

Tae Uk Kim ◽

Seong Jae Lee ◽

Seo Young Kim ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Motor Cortex ◽

Functional Recovery ◽

Treadmill Exercise ◽

Exercise Group ◽

Control Group ◽

Epigenetic Changes ◽

Cord Injury ◽

The Brain

Exercise training is a traditional method to maximize remaining function in patients with spinal cord injury (SCI), but the exact mechanism by which exercise promotes recovery after SCI has not been identified; whether exercise truly has a beneficial effect on SCI also remains unclear. Previously, we showed that epigenetic changes in the brain motor cortex occur after SCI and that a treatment leading to epigenetic modulation effectively promotes functional recovery after SCI. We aimed to determine how exercise induces functional improvement in rats subjected to SCI and whether epigenetic changes are engaged in the effects of exercise. A spinal cord contusion model was established in rats, which were then subjected to treadmill exercise for 12 weeks. We found that the size of the lesion cavity and the number of macrophages were decreased more in the exercise group than in the control group after 12 weeks of injury. Immunofluorescence and DNA dot blot analysis revealed that levels of 5-methylcytosine (5mC) and 5-hydroxymethylcytosine (5hmC) in the brain motor cortex were increased after exercise. Accordingly, the expression of ten-eleven translocation (Tet) family members (Tet1, Tet2, and Tet3) in the brain motor cortex also elevated. However, no macrophage polarization was induced by exercise. Locomotor function, including Basso, Beattie, and Bresnahan (BBB) and ladder scores, also improved in the exercise group compared to the control group. We concluded that treadmill exercise facilitates functional recovery in rats with SCI, and mechanistically epigenetic changes in the brain motor cortex may contribute to exercise-induced improvements.

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AAV2-mediated and hypoxia response element-directed expression of bFGF in neural stem cells showed therapeutic effects on spinal cord injury in rats

Cell Death and Disease ◽

10.1038/s41419-021-03546-6 ◽

2021 ◽

Vol 12 (3) ◽

Author(s):

Sipin Zhu ◽

Yibo Ying ◽

Jiahui Ye ◽

Min Chen ◽

Qiuji Wu ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Clinical Trials ◽

Control Group ◽

Therapeutic Effects ◽

Hypoxia Response Element ◽

Neurofilament Protein ◽

Response Element ◽

Hypoxia Response ◽

Cord Injury

AbstractNeural stem cell (NSCs) transplantation has been one of the hot topics in the repair of spinal cord injury (SCI). Fibroblast growth factor (FGF) is considered a promising nerve injury therapy after SCI. However, owing to a hostile hypoxia condition in SCI, there remains a challenging issue in implementing these tactics to repair SCI. In this report, we used adeno-associated virus 2 (AAV2), a prototype AAV used in clinical trials for human neuron disorders, basic FGF (bFGF) gene under the regulation of hypoxia response element (HRE) was constructed and transduced into NSCs to yield AAV2-5HRE-bFGF-NSCs. Our results showed that its treatment yielded temporally increased expression of bFGF in SCI, and improved scores of functional recovery after SCI compared to vehicle control (AAV2-5HRE-NSCs) based on the analyses of the inclined plane test, Basso–Beattie–Bresnahan (BBB) scale and footprint analysis. Mechanistic studies showed that AAV2-5HRE-bFGF-NSCs treatment increased the expression of neuron-specific neuronal nuclei protein (NeuN), neuromodulin GAP43, and neurofilament protein NF200 while decreased the expression of glial fibrillary acidic protein (GFAP) as compared to the control group. Further, the expressions of autophagy-associated proteins LC3-II and Beclin 1 were decreased, whereas the expression of P62 protein was increased in AAV2-5HRE-bFGF-NSCs treatment group. Taken together, our data indicate that AAV2-5HRE-bFGF-NSCs treatment improved the recovery of SCI rats, which is accompanied by evidence of nerve regeneration, and inhibition of SCI-induced glial scar formation and cell autophagy. Thus, this study represents a step forward towards the potential use of AAV2-5HRE-bFGF-NSCs for future clinical trials of SCI repair.

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Effect of pelvic laparoscopic implantation of neuroprosthesis in spinal cord injured subjects: a 1-year prospective randomized controlled study

Spinal Cord ◽

10.1038/s41393-021-00693-7 ◽

2021 ◽

Author(s):

Helge Kasch ◽

Uffe Schou Løve ◽

Anette Bach Jønsson ◽

Kaare Eg Severinsen ◽

Marc Possover ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Outcome Measures ◽

Outcome Measure ◽

Secondary Outcome ◽

Controlled Study ◽

Control Group ◽

Walking Ability ◽

Data Set ◽

Cord Injury

Abstract Study design 1-year prospective RCT. Objective Examine the effect of implantable pulse generator and low-frequency stimulation of the pelvic nerves using laparoscopic implantation of neuroprosthesis (LION) compared with neuromuscular electrical stimulation (NMES) in SCI. Methods Inclusion criteria: traumatic spinal cord injury (SCI), age 18–55 years, neurological level-of-injury Th4–L1, time-since-injury >1 year, and AIS-grades A–B. Participants were randomized to (A) LION procedure or (B) control group receiving NMES. Primary outcome measure: Walking Index for Spinal Cord Injury (WISCI-II), which is a SCI specific outcome measure assessing ability to ambulate. Secondary outcome measures: Spinal Cord Independence Measure III (SCIM III), Patient Global Impression of Change (PGIC), Penn Spasm Frequency Scale (PSFS), severity of spasticity measured by Numeric Rating Scale (NRS-11); International Spinal Cord Injury data sets-Quality of Life Basic Data Set (QoLBDS), and Brief Pain Inventory (BPI). Results Seventeen SCI individuals, AIS grade A, neurological level ranging from Th4–L1, were randomized to the study. One individual was excluded prior to intervention. Eight participants (7 males) with a mean age (SD) of 35.5 (12.4) years were allocated to the LION procedure, 8 participants (7 males) with age of 38.8 (15.1) years were allocated to NMES. Significantly, 5 LION group participants gained 1 point on the WISCI II scale, (p < 0.013; Fisher´s exact test). WISCI II scale score did not change in controls. No significant changes were observed in the secondary outcome measures. Conclusion The LION procedure is a promising new treatment for individuals with SCI with significant one-year improvement in walking ability.

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Transplantation of Neural Stem/Progenitor Cells at Different Locations in Mice with Spinal Cord Injury

Cell Transplantation ◽

10.3727/096368913x670967 ◽

2014 ◽

Vol 23 (11) ◽

pp. 1451-1464 ◽

Cited By ~ 21

Author(s):

Hiroki Iwai ◽

Satoshi Nori ◽

Soraya Nishimura ◽

Akimasa Yasuda ◽

Morito Takano ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Progenitor Cells ◽

Functional Recovery ◽

Control Group ◽

Cord Injury ◽

Neural Stem Progenitor Cells ◽

Neurotropic Factor ◽

Transplantation Site

Transplantation of neural stem/progenitor cells (NS/PCs) promotes functional recovery after spinal cord injury (SCI); however, few studies have examined the optimal site of NS/PC transplantation in the spinal cord. The purpose of this study was to determine the optimal transplantation site of NS/PCs for the treatment of SCI. Wild-type mice were generated with contusive SCI at the T10 level, and NS/PCs were derived from fetal transgenic mice. These NS/PCs ubiquitously expressed ffLuc-cp156 protein (Venus and luciferase fusion protein) and so could be detected by in vivo bioluminescence imaging 9 days postinjury. NS/PCs (low: 250,000 cells per mouse; high: 1 million cells per mouse) were grafted into the spinal cord at the lesion epicenter (E) or at rostral and caudal (RC) sites. Phosphate-buffered saline was injected into E as a control. Motor functional recovery was better in each of the transplantation groups (E-Low, E-High, RC-Low, and RC-High) than in the control group. The photon counts of the grafted NS/PCs were similar in each of the four transplantation groups, suggesting that the survival of NS/PCs was fairly uniform when more than a certain threshold number of cells were transplanted. Quantitative RT-PCR analyses demonstrated that brain-derived neurotropic factor expression was higher in the RC segment than in the E segment, and this may underlie why NS/PCs more readily differentiated into neurons than into astrocytes in the RC group. The location of the transplantation site did not affect the area of spared fibers, angiogenesis, or the expression of any other mediators. These findings indicated that the microenvironments of the E and RC sites are able to support NS/PCs transplanted during the subacute phase of SCI similarly. Optimally, a certain threshold number of NS/PCs should be grafted into the E segment to avoid damaging sites adjacent to the lesion during the injection procedure.

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