M. Baumberger

A patient with chronic inflammatory demyelinating polyneuropathy (CIDP) developed Evans syndrome ... more A patient with chronic inflammatory demyelinating polyneuropathy (CIDP) developed Evans syndrome (hemolytic anemia/thrombocytopenia) 17 months after onset of symptoms despite different immunomodulatory treatments. A therapeutic approach with the chimeric monoclonal anti-CD20 antibody rituximab induced substantial improvement of CIDP and hematologic recovery. The patient remains in sustained remission 17 months after completion of therapy. Rituximab may represent a successful therapy in otherwise refractory CIDP.

Deep vein thrombosis and heterotopic ossification in spinal cord injury: a 3 year experience at the Swiss Paraplegic Centre Nottwil

by H. Knecht and M. Baumberger

Spinal Cord, 2003

Study design: Retrospective review of patient data. Objectives: (i) To determine the incidence an... more Study design: Retrospective review of patient data. Objectives: (i) To determine the incidence and time of deep vein thrombosis (DVT) under low molecular weight heparin (LMWH) prophylaxis in spinal cord injury (SCI), (ii) to determine the incidence and time of heterotopic ossi®cation (HO) and (iii) to assess a possible aetiologic relationship in the pathogenesis of DVT and HO. Setting: Swiss Paraplegic Centre, Nottwil. Methods: We analyzed the incidence of DVT and HO in 1209 SCI patients (275 ®rst rehabilitations) at the Swiss Paraplegic Centre Nottwil from 1998 to 2000. Clinical ®les and laboratory data were scrutinised for particularities preceding DVT and HO. Results: The incidence of DVT was 6.55% for ®rst rehabilitation compared to only 1.59% in all patients hospitalised. DVT was complicated by pulmonary embolism (PE) in 1.45% and 0.47% respectively. Incidence of HO was 8% for ®rst rehabilitation and 1.82% for all patients hospitalised. In ®rst rehabilitation patients the peak for DVT occurred around day 30 contrary to HO with a peak around day 120. In single patients HO was identi®ed by MRI as a rapidly progressing process. Laboratory pro®les were in¯ammatory in both HO and DVT. Increased physical activity preceding HO was observed in four patients. In two patients acute HO was complicated by ipsilateral DVT. Conclusion: Prophylaxis with LMWH and elastic stockings signi®cantly reduces the frequency of DVT during ®rst rehabilitation in SCI. DVT and HO are both associated with laboratory parameters of non-infectious in¯ammation. The later onset of HO coinciding with ongoing mobilisation, argues for a dierent pathogenetic mechanism. Acute HO of the hip region appears to favour ipsilateral DVT by well known thrombogenic mechanisms.

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Characteristics of sleep apnea syndrome in tetraplegic patients

by H. Knecht and M. Baumberger

Spinal Cord, 2002

Objective: To include a larger number of tetraplegics than in previous studies, in order to more ... more Objective: To include a larger number of tetraplegics than in previous studies, in order to more reliably characterize the pathogenesis and predisposing factors of sleep apnea in tetraplegia. Methods: Sleep breathing data and oxymetric values were investigated in 50 randomly selected tetraplegic patients and discussed in context with age, gender, BMI, neck circumference, type and height of lesion, time after injury, spirometric values and medication. A non-validated short questionnaire on daytime complaints was added. Results: Thirty-one patients out of 50 had an RDI 515, de®ned as sleep disordered breathing (SDB); 24 of them combined with an apnea index of 5 or more, these cases were diagnosed as sleep apnea syndrome (SAS). SAS was apparent in 55% and 20% of the studied men and women, respectively. Regression analyses showed no signi®cant correlation between RDI and lesion level, ASIA impairment scale or spirometric values. In contrast, a signi®cant correlation between RDI and age, BMI, neck circumference and time after injury could be shown. Kruskal-Wallis test for dichotomous non-parametric factors, such as gender, cardiac medication and daytime complaints, showed signi®cant dierences with regard to RDI. In contrast to able-bodied people with SAS, daytime complaints were only present in tetraplegic patients with severe pathology (RDI440). Conclusion: Incidence of SAS is high in tetraplegia, particularly in older male patients with large neck circumference, long standing spinal cord injury and under cardiac medication. As tetraplegics with RDI between 15 and 40 reported no daytime complaints and often have normal BMI, these tetraplegics are not clinically suspicious for SAS. The increased use of cardiac medication in tetraplegics with SAS may implicate a link between SAS and cardiovascular morbidity, one of the leading causes of death in tetraplegia.

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[Preclinical diagnosis of traumatic paraplegia or tetraplegia -- a prospective study in 100 patients]

Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS, 2006

To avoid neurological deterioration, traumatic spinal cord injury has to be recognized as early a... more To avoid neurological deterioration, traumatic spinal cord injury has to be recognized as early as possible. Aim of the study was to analyze alterations of the neurological level of injury in the preclinical interval. In a prospective observational study the clinical diagnoses of 100 patients referred to the Swiss Paraplegic Centre in Nottwil, Switzerland, were compared to the preclinical diagnoses. In 12 patients we observed neurological deterioration for more than 2 spinal segments. Six of these patients had been diagnosed preclinically with paraplegia at a neurological level of T4 or T5, whereas the evaluation in the hospital showed cervical spinal cord injury and tetraplegia. Possible reasons for this neurological deterioration can be secondary damages of the nervous tissue due to vascular, metabolic or biochemical mechanisms, transportation trauma or insufficient preclinical diagnostics. There is no evidence for a higher risk of secondary tissue damage for patients with cervica...

Subarachnoidalblutung durch autonome Dysreflexie

Der Urologe, 2013

Nearly all men with spinal cord injury suffer from neurogenic sexual dysfunction which is often t... more Nearly all men with spinal cord injury suffer from neurogenic sexual dysfunction which is often treated with phosphodiesterase-5 (PDE5) inhibitors. We describe a case of subarachnoid hemorrhage due to autonomic dysreflexia (AD) caused by sexual stimulation. Nitrates are frequently used for acute treatment of AD; however, the use of these drugs in combination with PDE5 inhibitors is contraindicated. Therefore, meticulous information from patients and relatives on the risk of AD and possible drug interactions is of vital importance.

Functional Electrical Stimulation in Spinal Cord Injury: Clinical Evidence versus Daily Practice

by M. Baumberger and Angela Frotzler

Biomedical Engineering / Biomedizinische Technik, 2000

Die präklinische Diagnose der traumatischen Querschnittlähmung - eine prospektive Studie an 100 Patienten

ains · Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, 2006

Management of respiratory problems unique to high tetraplegia

Spinal Cord, 1999

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Diaphragma pacing and Tetraplegia

Ten diaphragmatic pacemakers were implanted at the Swiss Paraplegic Centre within the last ten ye... more

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Purpose: To describe and compare the content of instruments that assess environmental factors usi... more

Querschnittlähmung: Akutbehandlung und Rehabilitation

Die Intensivmedizin, 2008

Clinical assessment of obesity in persons with spinal cord injury: validity of waist circumference, body mass index, and anthropometric index

Journal of Spinal Cord Medicine, 2011

Objective: To study the relationship of waist circumference (WC) and bioelectrical impedance anal... more Objective: To study the relationship of waist circumference (WC) and bioelectrical impedance analysis (BIA) and degree of agreement between anthropometric index (AI) and BIA, using BIA as a reference or 'gold standard'. The second objective is to study the relationship between body mass index (BMI) and BIA in subjects with spinal cord injury (SCI). Study design: Comparative cross-sectional study. Setting: Convenience sample at outpatient clinic of spinal cord center. Outcome measures: Estimation of obesity was made in 23 men with motor complete paraplegia (>1 year postinjury). Bland and Altman statistics were used to define level of agreement between AI and BIA, Pearson's r to describe correlation between WC and BIA and BMI and BIA. Results: Good agreement between BIA and AI with a small systematic difference in fat mass (FM) (mean difference: −0.28%, Pearson's r: 0.91) was found. The correlation between WC and the BIA (% FM) was very high (Pearson's r : 0.83). The correlation between WC and BMI (% FM) was just over moderate (Pearson's r : 0.51). Conclusion: AI seems to be a valid proxy measure to estimate obesity in males living with SCI. Measurement of obesity in persons with SCI based on WC is promising. BMI showed not to be valid to estimate obesity in persons with SCI.

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Nontraumatic Pancreatitis in Spinal Cord Injury

Spine, 2002

A retrospective analysis of 10 patients with pancreatitis after traumatic spinal cord injury. To ... more A retrospective analysis of 10 patients with pancreatitis after traumatic spinal cord injury. To determine the conditions leading to nontraumatic pancreatitis in spinal cord injury. Little is known in the literature about pancreatitis after spinal cord injury. A few authors suggest a multifactorial pathogenesis. Over a 4-year period the case reports of 338 patients with traumatically caused SCI were reviewed concerning p-amylase and/or lipase elevations. Acute pancreatitis was defined as an elevation of p-amylase and/or lipase of more than three times the upper normal limit. Ten of 338 patients had p-amylase and/or lipase elevations three times higher than the upper normal limit. All 10 were male with a mean age of 40.4 years. The average onset time of acute pancreatitis was 16 +/- 5.5 days after trauma. The usual etiologic factors of acute pancreatitis such as obstructive, toxic, or traumatic events were excluded. The clinical recognition of acute pancreatitis in paraplegic and quadriplegic patients is hampered by diminished or lost visceral sensitivity and therefore is based on laboratory investigations. The current authors therefore hypothesize that acute pancreatitis in the setting of high-level spinal cord injury may result from a combination of locally mediated sphincter of Oddi dysfunction and vagal dominant innervation of the pancreatic gland in autonomic failure.

Identification of the most common problems in functioning of individuals with spinal cord injury using the International Classification of Functioning, Disability and Health

by M. Baumberger and A. Sinnott

Spinal Cord, 2010

Cross-sectional, multicenter study. To identify the most common problems of individuals with spin... more Cross-sectional, multicenter study. To identify the most common problems of individuals with spinal cord injury (SCI) in the early post-acute and the long-term context, respectively, using the International Classification of Functioning, Disability and Health (ICF) as a frame of reference. International. The functional problems of individuals with SCI were recorded using the 264 ICF categories on the second level of the classification. Prevalence of impairment was reported along with their 95% confidence intervals. Data were stratified by context. Sixteen study centers in 14 countries collected data of 489 individuals with SCI in the early post-acute context and 559 in the long-term context, respectively. Impairments in thirteen ICF categories assigned to Body functions and Body structures were more frequently reported in the long-term context, whereas limitations/restrictions in 34 ICF categories assigned to Activities and Participation were more frequently found in the early post-acute context. Eleven ICF categories from the component Environmental Factors were more frequently regarded as barriers, facilitators or both by individuals with SCI in the early post-acute context as compared with individuals with SCI in the long-term context. Only two environmental factors were more relevant for people with SCI in the long-term context than in the early post-acute context. The study identified a large variety of functional problems reflecting the complexity of SCI and indicated differences between the two contexts. The ICF has potential to provide a comprehensive framework for the description of functional health in individuals with SCI worldwide.

Development and validation of a self-report version of the Spinal Cord Independence Measure (SCIM III)

Spinal Cord, 2013

Study design: Cross-sectional validation study. Objectives: To develop and validate a self-report... more Study design: Cross-sectional validation study. Objectives: To develop and validate a self-report version of the Spinal Cord Independence Measure (SCIM III). Setting: Two SCI rehabilitation facilities in Switzerland. Methods: SCIM III comprises 19 questions on daily tasks with a total score between 0 and 100 and subscales for 'self-care', 'respiration & sphincter management' and 'mobility'. A self-report version (SCIM-SR) was developed by expert discussions and pretests in individuals with spinal cord injury (SCI) using a German translation. A convenience sample of 99 inpatients with SCI was recruited. SCIM-SR data were analyzed together with SCIM III data obtained from attending health professionals. Results: High correlations between SCIM III and SCIM-SR were observed. Pearson's r for the total score was 0.87 (95% confidence interval CI) 0.82-0.91), for the subscales self-care 0.87 (0.81-0.91); respiration & sphincter management 0.81 (0.73-0.87); and mobility 0.87 (0.82-0.91). Intraclass correlations were: total score 0.90 (95% CI 0.85-0.93); self-care 0.86 (0.79-0.90); respiration & sphincter management 0.80 (0.71-0.86); and mobility 0.83 (0.76-0.89).

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The importance of posture on the isokinetic assessment of spasticity

Spinal Cord, 2002

To measure spasticity of the knee flexors and extensor muscles in two different hip positions. Sw... more To measure spasticity of the knee flexors and extensor muscles in two different hip positions. Swiss Paraplegic Center Nottwil, Switzerland. Twenty spinal cord injured (SCI) patients with complete lesions were tested with a torque-velocity dynamometer in the following positions: (1) supine with a hip angle of 0 degrees; (2) sitting with a hip angle of 90 degrees. The excursion of the knee was measured for both positions using a goniometer. Two flexion/extension movements of the knee were performed at a speed of 10 degrees per sec. A further four flexion/extension movements over the same trajectory were made at a speed of 120 degrees per sec. Eccentric peak torques were measured continuously during movement of both legs for both speeds. At a speed of 120 degrees per second, there was a significant difference in stretch reflex of the hamstrings and quadriceps femoris muscles for the two positions (Wilcoxon&#39;s paired t-test, P&lt;0.05). Excitability was higher for the quadriceps femoris muscles in supine than in sitting position. For the hamstrings, the effect was reversed. Significant differences between sitting and supine position were not found for the speed of 10 degrees per sec. Test-retest reliability was high for the movements of 120 degrees per sec but low for 10 degrees per sec. Our findings indicate that for a reliable and comparable measurement of spasticity, an exact description of test position and procedure is essential.

Spinal cord injury-related chronic pain in victims of the 2008 Sichuan earthquake: a prospective cohort study

Spinal Cord, 2013

Prospective cohort. To characterize spinal cord injury (SCI)-related pain and treatment in victim... more Prospective cohort. To characterize spinal cord injury (SCI)-related pain and treatment in victims of the 2008 Sichuan earthquake. Mianzhu County, China. Twenty-six patients who sustained SCI in the 2008 Sichuan earthquake and who were treated in the same hospital were enrolled. Data was collected on pain severity with a visual analog scale, depression with Patient Health Questionnaire-9, quality of life (QoL) with World Health Organization Quality of Life-BREF and social participation with the Craig Hospital Handicap Assessment and Reporting Technique Short Form at three assessment points. Detailed pain descriptions including therapeutic interventions were elicited at the fourth assessment. Pain determinants were analyzed with a longitudinal Tobit regression, and Pearson&#39;s correlations of pain severity with depression, QoL and social participation stratified by measurement point were calculated. SCI-related pain was highly prevalent and prevalence of neuropathic pain was nearly twice that of nociceptive pain. Most patients reported pain since the onset and severity was not significantly reduced over time. Cervical injury, complete lesions and education level were significant pain determinants. Depression and QoL scores were highly correlated with pain at the first two assessments points but not at the third measurement. Most patients did not seek treatment because they regarded pain as either a normal condition after SCI or were afraid of drug dependency. This initial longitudinal assessment and characterization of SCI-related pain in earthquake victims provides a foundation for further exploration of the biological and psychosocial determinants of pain severity and of the correlation of chronic pain with other outcomes of interest in this population. Patient pain-treatment-seeking behavior and therapeutic interventions should be evaluated concurrently.

ICF Core Sets for individuals with spinal cord injury in the early post-acute context

by M. Baumberger and A. Sinnott

Spinal Cord, 2010

A formal decision-making and consensus process integrating evidence gathered from preparatory stu... more A formal decision-making and consensus process integrating evidence gathered from preparatory studies was followed. The aim of this study was to report on the results of the consensus process to develop the first version of a Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set and a Brief ICF Core Set for individuals with spinal cord injury (SCI) in the early post-acute context. The consensus conference took place in Switzerland. Preparatory studies were performed worldwide. Preparatory studies included an expert survey, a systematic literature review, a qualitative study and empirical data collection involving people with SCI. ICF categories were identified in a formal consensus process by international experts from different backgrounds. The preparatory studies identified a set of 531 ICF categories at the second, third and fourth levels. From 30 countries, 33 SCI experts attended the consensus conference (11 physicians, 6 physical therapists, 5 occupational therapists, 6 nurses, 3 psychologists and 2 social workers). Altogether 162 second-, third- or fourth-level categories were included in the Comprehensive ICF Core Sets with 63 categories from the component Body Functions, 14 from Body Structures, 53 from Activities and Participation and 32 from Environmental Factors. The Brief Core Set included a total of 25 second-level categories with 8 on Body Functions, 3 on Body Structures, 9 on Activities and Participation, and 5 on Environmental Factors. A formal consensus process-integrating evidence and expert opinion based on the ICF led to the ICF Core Sets for individuals with SCI in the early post-acute context. Further validation of this first version is needed.

Characteristics of sleep apnea syndrome in tetraplegic patients

Spinal Cord, 2002

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Long-term follow-up of patients with spinal cord injury with a new ICF-based tool

by M. Baumberger and Markus Wirz

Spinal Cord, 2011

Study design: To develop a computer program that supports the overview of a follow-up care proces... more Study design: To develop a computer program that supports the overview of a follow-up care process in people with spinal cord injury (SCI) in daily clinical practice. Objectives: To create a new electronic tool based on the International Classification of Functioning, Disability and Health (ICF) that enables information to be registered and visualized, including the use of a net-diagram ('spider') to show a patient's long-term development. This diagram helps the clinician to recognize predispositions over time, as well as making information accessible to the patient, so as to involve him as a participant in defining current and future treatment options. Furthermore, guidelines for the prevention of common diseases, based on the recommendations of internal medicine, rehabilitation medicine and findings in the SCI literature, were implemented to provide enhanced health coaching in the area of preventative care. Methods: In an outpatient setting, four perspectives were assessed: patient, physician, occupational therapist and physiotherapist for a comprehensive bio-psycho-social consideration. All categories were assessed and graphically visualized with the electronic tool, on the basis of the ICF domains: body function, activities/participation and environmental factors. Results: The assessed data were summarized and graphically represented using three spider charts. Conclusion: The tool facilitates the patient counselling and the interdisciplinary work in daily clinical practice. Such a visual report helps to recognize predispositions over time. Furthermore, it helps to explain the clinical and patient-related findings accessible to the patients, to involve them as participants in defining the goals and the treatment plan.

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Sustained remission of CIDP associated with Evans syndrome

by H. Knecht and M. Baumberger

Neurology, 2004