Spinal Cord Injuries

Apolipoprotein E (apo-E), a protein involved in lipid metabolism and cholesterol transport, has been found to be up-regulated in CNS injury and is associated with Alzheimer's disease in humans. In this study, we show that apo-E is also up-regulated after complete spinal cord transection in the C57BL/6 mouse. In the uninjured cord, the cellular localization of apo-E protein is in astrocytes, in individual neurons throughout the laminae except for the dorsal horn, and in endothelial cells of capillaries in the immediate vicinity of those neurons. After injury, RNA levels are elevated as early as 4 days and reach a maximal level between 1 and 2 weeks. Protein levels follow closely but remain up-regulated beyond 3 weeks. Early on, the protein can be found in neutrophils and macrophages at the injury site and only at later times in astrocytes during the remodeling of white matter tracts, most prominently in degenerating parts of the fasciculus gracilis.

Background: The aim of this study is to clarify the neural mechanisms underlying orofacial pain abnormalities after cervical spinal nerve injury. Nocifensive behavior, phosphorylated extracellular signal-regulated kinase (pERK) expression and astroglial cell activation in the trigeminal spinal subnucleus caudalis (Vc) and upper cervical spinal dorsal horn (C1-C2) neurons were analyzed in rats with upper cervical spinal nerve transection (CNX). Results: The head withdrawal threshold to mechanical stimulation of the lateral facial skin and head withdrawal latency to heating of the lateral facial skin were significantly lower and shorter respectively in CNX rats compared to Sham rats. These nocifensive effects were apparent within 1 day after CNX and lasted for more than 21 days. The numbers of pERK-like immunoreactive (LI) cells in superficial laminae of Vc and C1-C2 were significantly larger in CNX rats compared to Sham rats following noxious and non-noxious mechanical or thermal sti...

Although spinal injury is a major cause of chronic disability, the mechanisms responsible for the lesion pathophysiology and their dynamic evolution remain poorly understood. Hence, current treatments aimed at blocking damage extension are unsatisfactory. To unravel the acute spinal injury processes, we have developed a model of the neonatal rat spinal cord in vitro subjected to kainate-evoked excitotoxicity or metabolic perturbation (hypoxia, aglycemia, and free oxygen radicals) or their combination. The study outcome is fictive locomotion one day after the lesion and its relation to histological damage. Excitotoxicity always suppresses locomotor network activity and produces large gray matter damage, while network bursting persists supported by average survival of nearly half premotoneurons and motoneurons. Conversely, metabolic perturbation simply depresses locomotor network activity as damage mainly concerns white rather than gray matter. Coapplication of kainate and metabolic perturbation completely eliminates locomotor network activity. These results indicate distinct cellular targets for excitotoxic versus dysmetabolic damage with differential consequences on locomotor pattern formation. Furthermore, these data enable to estimate the minimal network membership compatible with expression of locomotor activity.

Objective: To identify the relationship between two aspects of aging (age at injury onset and years since injury onset) with the post-injury prevalence of six classes of secondary conditions among a sample of participants with spinal cord injury (SCI). Design: A cross-sectional study to identify the relationship between the two aging variables and secondary conditions after spinal cord injury. Setting: A large southeastern rehabilitation hospital, with the collaboration of two midwestern hospitals. Participants: Three hundred and forty-seven participants, all of whom had traumatic SCI of an average duration of 18.2 years. Main outcome measures: The Secondary Conditions Questionnaire (SCQ), a 50-item selfreport screening measure for secondary conditions after SCI, was used to measure the postinjury prevalence of six classes of secondary conditions. Results: There was a signi®cantly greater odds of kidney stones, non-urinary related infections, and three types of musculoskeletal conditions (ie, curvature of the spine, contractures, and fractures) among participant cohorts who were 20 ± 29 years post-injury and 30 or more years post-injury. The odds of heart problems and bowel obstructions were higher with a greater age at injury onset, whereas the odds of seven other conditions decreased among older cohorts at injury. Among these seven conditions, the most dramatic ®ndings were for kidney stones, where individuals who were less than 18 at injury had over 30 times the odds of having had the condition since injury than those who were injured at 40 or older. Conclusions: Although the study was cross-sectional in nature, the results point to secondary conditions which may be problematic with increasing years since injury, as well as those conditions which are more or less likely to occur among individuals injured at dierent points in their lives.

Conflicting findings exist regarding the link between functional recovery and the regrowth of spinal tracts across the lesion leading to the restoration of functional contacts. In the present study, we investigated whether functional locomotor recovery was attributable to anatomical regeneration at postnatal day 1 (PN1), PN7, PN14 and in adult rats two months after transection injury at the tenth thoracic segment of the spinal cord. The Basso, Beattie, and Bresnahan scores showed that transection led to a failure of hindlimb locomotor function in PN14 and adult rats. However, PN1 and PN7 rats showed a significant level of stepping function after complete spinal cord transection. Unexpectedly, unlike the transected PN14 and adult rats in which the spinal cord underwent limited secondary degeneration and showed a scar at the lesion site, the rats transected at PN1 and PN7 showed massive secondary degeneration both anterograde and retrograde, leaving a >5-mm gap between the two stumps. Furthermore, retrograde tracing with fluorogold (FG) also showed that FG did not cross the transection site in PN1 and PN7 rats as in PN14 and adult rats, and re-transection of the cord caused no apparent loss in locomotor performance in the rats transected at PN1. Thus, these three lines of evidence strongly indicated that the functional recovery after transection in neonatal rats is independent of regrowth of spinal tracts across the lesion site. Our results support the notion that the recovery of locomotor function in developing rats may be due to intrinsic adaptations in the spinal circuitry below the lesion that control hindlimb locomotor activity rather than the regrowth of spinal tracts across the lesion. The difference in secondary degeneration between neonatal and adult rats remains to be explored.

Study design: A retrospective hospital-based study. Objectives: To describe the epidemiologic features of traumatic spinal cord injury (TSCI) in Anhui Province. Setting: Two hospitals within Anhui Province, China. Methods: We retrospectively reviewed the hospital records on all patients with TSCI, admitted between 1 January 2007 and 31 December 2010 (n ¼ 761). Variables included age, gender, occupation, neurological level, severity of injury, cause and treatment. Results: Seven hundred and sixty-one cases of TSCI were identified. Five hundred and eighty eight were males (77.3%) and 173 were females (22.7%), with a mean age of 45 years (s.d. ¼ 13, range from 5 to 87). Fall from height was the leading cause of injury (52.6%), followed by transport (21.2%). The neurological lesion levels were cervical (46.3%), lumbosacral (33.3%) and thoracic (20.4%). Conclusion: Prevention strategies for TSCI should target 30-60 age group, males, farmers and fall from height. The results of this study will serve as a basis for further studies on TSCI. The prevention strategies and treatment should be designed according to the injury features.

The current etiopathogenesis of spinal cord injury comprises a growing number of nontraumatic causes, including ischemia generating hypoxic-dysmetabolic conditions. To mimic the metabolic disruption accompanying nontraumatic acute spinal cord injury and to characterize the type and dynamics of cell death in relation to locomotor network function, we used, as a model, the rat neonatal spinal cord preparation in vitro transiently (1 h) exposed to a "pathological medium" (PM), i.e. hypoxic/aglycemic solution containing toxic radicals. PM induced, in the ventrolateral spinal region, pyknosis already detectable after 2 h and stabilized 24 h later (affecting 55% of white matter cells). Glial cells were much more vulnerable than neurons. The amplitude of fictive locomotor patterns recorded from lumbar ventral roots was decreased and periodicity delayed by PM, in keeping with substantial preservation of neuronal networks. Repeated application of PM intensified such a functional impairment. polymerase-1 (PARP-1) (the active caspase-3 executor) also grew with similar time course. The caspase-3 inhibitor II counteracted, in a dose-dependent fashion, white matter pyknosis. Our results suggest the important involvement of apoptotic pathways in early glial cell death during the first 24 h after a hypoxic-dysmetabolic insult, associated with impaired locomotor output. Residual locomotor network activity together with distinctive apoptotic damage to white matter cells suggests that early protection against glial destruction may help to prevent subsequent damage extension responsible for paraplegia.

The aim of this study was to investigate the use of functional electrical stimulation (FES) as a means of pressure sore prevention in seated spinal cord injured (SCI) subjects. Nine SCI subjects took part in tests in which electrical stimulation was applied to the quadriceps with the lower legs restrained. Ischial pressures were measured during periods of quiet sitting and FES application. A strain gauged lever arm was used to measure the knee moment during quadriceps stimulation. The average pressure drop at the right and left buttocks was 44 mmHg and 27 mmHg respectively. In general the greatest reductions occurred in subjects with larger knee moments; however, there was no direct relationship between the pressure reduction obtained and the quadriceps strength. This form of FES may be useful as a prophylactic aid in the management of pressure sores in SCI subjects.

A group of patients who are good candidates for the application of Functional Electrical Stimulation (FES) to restore reciprocal walking is described. They have incomplete lesions of the spinal cord. Because of the degree of preserved voluntary control, proprioception and sensation some of these patients can achieve crutch assisted walking by means of multichannel electrical stimulation: In a number of cases the patient has sufficient strength and voluntary control in the upper limbs and at least one leg to provide safe standing for short periods in forearm crutches. For these patients a two channel stimulator controlled by a handswitch was applied to achieve safe and practical crutch assisted walking in a relatively short period of time.

Background/Objective: Below-level central neuropathic pain, a diffuse pain characterized by generalized burning, is commonly experienced by individuals with spinal cord injury (SCI) . The objective of this study was to investigate the effects of an electroacupuncture protocol for the treatment of below-level central neuropathic pain developed at the

Intravesical botulinum toxin A (BoNTA) injection has been widely used for the treatment of detrusor overactivity in patients with neurogenic bladder due to spinal cord injury who do not respond to conventional treatment. There is no consensus about antibiotic prophylaxis for this procedure. We conducted a retrospective analysis of medical records of adult patients with spinal cord injury who underwent detrusor BoNTA injection between January of 2007 and December of 2013 in a rehabilitation hospital. Occurrence of symptomatic urinary tract * Corresponding author.

Intravesical botulinum toxin A (BoNTA) injection has been widely used for the treatment of Q2 detrusor overactivity in patients with neurogenic bladder due to spinal cord injury who do not respond to conventional treatment. There is no consensus about antibiotic prophylaxis for this procedure. We conducted a retrospective analysis of medical records of adult patients with spinal cord injury who underwent detrusor BoNTA injection between January of 2007 and December of 2013 in a rehabilitation hospital. Occurrence of symptomatic urinary tract * Corresponding author.

Background Bowel dysfunction amongst multiple sclerosis (MS) and spinal cord injury (SCI) patients often manifests as fecal incontinence (FI) or constipation, but the pathophysiology is poorly understood. Anorectal physiology provides an objective assessment of lower bowel functions and is increasingly being used in clinical practice. Aim The purpose of this study was to correlate symptoms of bowel dysfunction in patients with spinal cord disease with findings in anorectal physiology. We hypothesized that specific abnormalities will correlate with symptoms: prolonged recto-anal inhibitory reflex in patients with incontinence and decreased rectal mucosal blood flow in patients with constipation. Methods Forty-nine patients with MS (35 with predominant FI and 14 constipation), 46 supraconal SCI (mixed symptom load), and 21 healthy volunteers matched for age and sex were studied. Subjects completed validated constipation and FI symptom questionnaires. Patients underwent standard anorectal physiology, including assessment of rectal mucosal blood flow and recto-anal inhibitory reflex (RAIR). Results Severity of constipation correlates significantly with distension sensitivity (urge volume [r = 0.68, p = 0.002] and maximal volume [r = 0.39, p = 0.03]). Severity of constipation also correlated with diminished rectal mucosal blood flow in both patient groups (r = -0.51, p = 0.006). In both groups, constipation correlated with diminished relaxation of the sphincters in the RAIR whilst fecal incontinence correlated with a prolonged duration of RAIR (r = 0.33, p = 0.009) and recovery phase (r = 0.37, p = 0.05). Conclusion Bowel symptoms in patients with MS and SCI correlate with specific alterations of anorectal physiology. This provides objective assessment of bowel symptoms and may allow tailored treatment to individual patients.

Study design: Observational, cross-sectional study from a convenience sample with pretest/posttest data from a sample subset. Objectives: Determine the presence of walking-related arm swing after spinal cord injury (SCI), its associated factors and whether arm swing may change after locomotor training (LT).

Background-Spinal cord injury affects walking balance control, which necessitates methods to quantify balance ability. The purposes of this study were to 1) examine walking balance through foot placement variability post-injury; 2) assess the relationship between measures of variability and clinical balance assessments; and 3) determine if spatial parameter variability might be used as a clinical correlate for more complex balance measurements. Methods-Ten persons with spinal cord injury walked without devices on a split-belt treadmill at self-selected speeds. Ten healthy controls walked at 0.3 and 0.6 m/s for comparison. Variability of step width and length, anteroposterior and mediolateral foot placements relative to center-of-mass,

This article uses Heidegger's notion of humanp temporality to illuminate the meaning of the temporal disruption that can occur after traumatic spinal cord injury (TSCI). Though time is seen as important in rehabilitation practice, especially in occupational theory, it is often conceptualised in linear terms thus missing its existential structure. Our goal in this article is to enhance researchers' and rehabilitation clinicians' ways of doing and thinking about rehabilitation by revealing and articulating the role of human temporality in recovery and re-habilitation in the case of TSCI. Data come from ethnographic observations and field notes from one rehabilitation facility, interviews with former and current patients of spinal units and interviews with allied health staff who work with adults with TSCI. We discuss research and practice implications of this work for allied health staff in identifying ways of bringing this new approach to temporality into practice.

Data on the prevalence of malnutrition among patients with spinal cord injuries (SCI) are lacking. The aim of the present study was to assess nutritional risk at admission, and the status of nutritional support in the UK SCI Centres (SCIC); a cross-sectional, multicentre study in four SCIC. A standardised questionnaire was used and distributed to the participating SCIC. After obtaining informed consent, baseline demographic data, nutritional risk score by the ‘Malnutrition Universal Screening Tool’, BMI and routine blood biochemistry were collected from every patient admitted to an SCIC. The four SCIC, comprising 48·2 % of the total UK SCI beds, contributed data from 150 patients. On admission, 44·3 % of patients were malnourished or at risk of undernutrition. Nutritional risk was more common in patients with acute high cervical SCI than those with lower SCI (60·7 v. 34·5 %), and nutritional risk was more common in those with additional complications including ventilatory support (w...

Study design: This study was a randomized, parallel-group, controlled clinical trial. Objectives: The purpose of this study was to examine the efficacy of targeting inflammation as a means of improving cognitive function in individuals with spinal cord injury. Setting: Participants were recruited from the Niagara region of Ontario Canada and all testing occurred on-site at Brock University. Methods: Indices of memory and verbal learning were assessed by means of the California Verbal Learning Test (CVLT). Inflammation and concentrations of neuroactive compounds related to the kynurenine pathway were assessed via a number of pro-and anti-inflammatory cytokines, as well as tryptophan, kynurenine and several large neutral amino acids. All assessments were performed at baseline as well as at 1 month and 3 months during a 3-month intervention by means of an anti-inflammatory diet. Results: Despite a reduction in inflammation, all measures of the CVLT, including list A, trial 1 (P = 0.48), learning slope (P = 0.46), long delay free recall (P = 0.83), intrusions (P = 0.61) and repetitions (P = 0.07), showed no significant group × time interaction. Conclusion: It may be possible that the reduction in inflammation achieved in the current study was insufficient to induce substantial changes in indices of verbal learning and memory. Alternatively, as these participants likely underwent years of previous chronic inflammation, the underlying hippocampal damage may have negated potential improvements induced by acute reductions in inflammation.

Functional magnetic resonance imaging of the spinal cord (spinal fMRI) has facilitated the noninvasive visualization of neural activity in the spinal cord (SC) and brainstem of both animals and humans. This technique has yet to gain the widespread usage of brain fMRI, due in part to the intrinsic technical challenges spinal fMRI presents and to the narrower scope of applications it fulfills. Nonetheless, methodological progress has been considerable and rapid. To date, spinal fMRI studies have investigated SC function during sensory or motor task paradigms in spinal cord injury (SCI), multiple sclerosis (MS) and neuropathic pain (NP) patient populations, all of which have yielded consistent and sensitive results. The most recent study in our laboratory has successfully used spinal fMRI to examine cervical SC activity in a SCI patient with a metallic fixation device spanning the C 4 to C 6 vertebrae, a critical step in realizing the clinical utility of the technique. The literature reviewed in this article suggests that spinal fMRI is poised for usage in a wide range of patient populations, as multiple groups have observed intriguing, yet consistent, results using standard, readily available MR systems and hardware. The next step is the implementation of this technique in the clinic to supplement standard qualitative behavioral assessments of SCI. Spinal fMRI may offer insight into the subtleties of function in the injured and diseased SC, and support the development of new methods for treatment and monitoring.

Study design: Retrospective analysis of a prospectively collected trauma database of a Level 1 (tertiary) trauma center. Objective: To de®ne the features of the cervical spinal injuries in polytrauma population admitted to the regional trauma unit. Setting: Canada, Ontario Province, Toronto, Sunnybrook Health Sciences Center. Methods: All trauma admissions between 1987 and 1996 entered prospectively into a trauma registry database were studied for incidence, demographic and epidemiological details of cervical spine (cord and column) injuries. Results: A total of 468 patients (66% male) with cervical spinal injury (CSI) from 1198 spinal injuries admitted to the regional trauma center were identi®ed. Seventy-®ve per cent of the CSI involved were aged less than 50 years; nearly 30% were in the third decade alone. Overall, the commonest spinal level injured was C2 (27%) followed by C5 (22%). Older population (above 60 years of age) had C1+2 involved more often than the young (P=0.02). Motor vehicular crashes (MVC) accounted for 71%, followed by pedestrian trauma (10%), sport injuries (7%). Spinal cord injury (SCI) was noted in 27%; complete in 16% and incomplete in 11% and more frequently at C4 or C5 level compared with C1, C2 (P50.00001); the former level had more often a complete SCI (P=0.06). Though MVC produced 74% of SCI, only 27% had neurological de®cits. Recreational trauma produced SCI in 45%, motor cycle crashes (MCC) in 37% and a rear passenger in MVC in 34% that was complete in 78%, 71% and 73% respectively. Front seat passenger and driver in MVC had a C5 level injury while a rear seat passenger had at C4 (P50.001). The C1 level injury had high association with severe and life threatening head and neck and facial injuries compared with the more frequently injured spinal levels; either C2 (P=0.03) or C5 (P=0.004). Similarly C1 injuries had higher ISS compared with C2 (P50.0001) and C5 (P50.008). Conclusions: C2 was the commonest fractured spine while SCI was more frequent at C5. Older and pedestrian population had higher incidences of injuries at C1 and C2. Sport and MCC resulted in severe SCI. The level of spine injured was dierent between a front and a rear seat occupant in MVC.

Influencia de la satisfacción de los pacientes de una unidad de diálisis en la adherencia terapéutica Accésit Premio de investigación en enfermería nefrológica Janssen-Cilag Existen múltiples factores que parecen estar relacionados con la deficiente adhesión terapéutica farmacológica. El objetivo de este trabajo ha sido valorar el grado de adherencia al tratamiento farmacológico de los pacientes en tratamiento renal sustitutivo de nuestra unidad, así como su posible relación con el grado de satisfacción de los pacientes con la atención recibida. Se estudiaron un total de 85 pacientes (tasa de respuesta de 87% en hemodiálisis y 100% en diálisis peritoneal). El 52,27% de los pacientes en hemodiálisis no tenían adherencia con el tratamiento farmacológico mientras que el 47,73% si la tenían. No encontramos correlación entre la satisfacción media global de los pacientes en hemodiálisis y su adherencia al tratamiento. Tras análisis del test Morisky-Green, las principales causas de no adhesión al régimen terapéutico son, "deja de tomar la medicación cuando les sienta mal" (40%) y un 17,4% "se olvida alguna vez de tomar los medicamentos"; sin embargo más del 95% de los pacientes toman la medicación a la hora indicada y no suspenden el tratamiento cuando se encuentran bien. No hemos encontrado correlación entre la adherencia al tratamiento farmacológico y las variables sociodemográficas estudiadas.

OBJECTIVE Infections caused by multidrug-resistant gram-negative organisms (MDRGNOs) have been increasing every year. The objective of this study was to describe the prevalence of MDRGNOs and factors associated with MDRGNOs in patients with spinal cord injury or disorder (SCI/D). DESIGN Retrospective cohort study. METHODS Department of Veterans Affairs (VA) electronic health record data from 142 VA facilities were evaluated for 19,642 patients with SCI/D. Multivariable cluster-adjusted models were fit to identify factors associated with MDRGNO. RESULTS Gram-negative (GN) cultures occurred in 44% of patients with SCI/D receiving care at VA facilities, and 11,527 (41.3%) GN cultures had an MDRGNO. The most frequent GN organisms (GNOs) were Escherichia coli (28.5%), Klebsiella pneumoniae (17.0%), and Pseudomonas aeruginosa (16.0%). Two-thirds of GN cultures were from the outpatient setting, where MDRGNO prevalence was 37.6%. Significant geographic variation in the prevalence of MDRGNOs...

A 32-year-old man presented with a combined penetrating stab injury of the spinal cord and the aorta caused by a knife wound in his back at the low thoracic level. The knife had broken, and part of the blade had been retained in the wound, passing through the spinal canal and into the aortic lumen. The patient was treated in two steps: the aorta was repaired by a thoracotomy, then spinal exploration was carried out through a laminectomy. Because of the tamponade effect of the foreign body, it was necessary to delay removal of the blade until vascular control had been achieved. Any sign of a penetrating body passing through the spine should suggest careful evaluation to detect any visceral injury, and multidisciplinary treatment should be planned.

INTRODUCTION: The objective of this study is to analyze the outcome of surgery in spinal decompression in patient who was diagnosed as traumatic cauda equina syndorme (CES) in relation to time to surgery as variable to determine its association with outcomes in CES. MATERIALS & METHODS: This is a retrospective study. All patients was selected at a single center whose medical record allowed precise calculation of time to surgery were included. CES was defined as perineal anesthesia and other lumbosacral root sensory deficits, lower extremity weakness, difficulty with bladder and bowel control, sexual dysfunction, low back pain, and unilateral or bilateral sciatica. CES can be divided into two types, complete or incomplete. Complete CES presented with saddle anesthesia and bladder or bowel retention/incontinence, while incomplete CES patients presented with saddle anesthesia but with minor bladder and bowel dysfunction such as loss of urgency or altered urinary sensorium. Outcome of s...

Anterior stab wounds to the spine are extremely rare. Depending on the weapon, trajectory and anatomical level, patients are likely to present with associated damage to large vessels, the lungs, heart, and the gastrointestinal, as well as genitourinary system. In this case report, we describe the management of a 21-year-old male patient who presented with an injury to the cauda equina after an abdominal stab with a glass bottle. The patient escaped a thorough secondary survey and neurological examination due to massive intra-abdominal injuries, which required initial damage control surgery. Weak left-sided dorsiflexion of the ankle with paraesthesia in the left L4 and L5 nerve root distribution was initially overlooked. During a follow-up appointment, one month after discharge, chronic pain and cauda equina symptoms were noted. Further imaging revealed a large glass fragment, which had been driven, transabdominally, through the L4/L5 disc into the spinal canal. The fragment was removed through a posterior approach, which alleviated the chronic pain, although the neurological deficit remained unchanged. Neurological damage through anterior stab wounds to the spine has not yet been described. The best approach to these patients is a staged management initially directed at treating life-threatening injuries in the form of damage control surgery. Once stable, a thorough neurological reassessment must follow to rule out spinal cord injuries

In adult patients, Spinal Cord Injury (SCI) may influence the mental Body Representation (BR). Currently, there is no evidence on the modulation of SCI on BR during early stages of cognitive development. Here, we investigated BR in a 3-year-old child with complete SCI. The patient was administered with a specific battery assessing different BR components. We found evidence for putative classical neuropsychological dissociation between a preserved topological map with impaired semantic knowledge of the body. This finding sheds new light on the impact of SCI on BR in childhood, as well as on the level of interdependence between BR's components..

Spinal cord injury (SCI) is less common in children than in adults, but in children it is generally more severe. Spinal loading conditions (speed and displacement) are also thought to affect SCI severity, but the relationship between these parameters is not well understood. This study aimed to investigate the effects of vertebral speed and displacement on the severity of SCI in infants and adults using a rodent model of vertebral dislocation. Thoracolumbar vertebral dislocation was induced in anaesthetized infant rats (*30 g, 13-15 days postnatal, n = 40) and adult rats (*250 g, n = 57). The 12th thoracic vertebra was secured, whereas the first lumbar vertebra was dislocated laterally. Dislocation speed and magnitude were varied independently and scaled between adults and infants (Adults: 100-250mm/s, 4-10mm; Infants: 40-100mm/s, 1.6-4mm). At 5 h post-injury, rats were euthanized and spinal cords harvested. Spinal cord sections were stained to detect hemorrhage (hematoxylin and eosin) and axonal injury (b-amyloid precursor protein). For each millimeter increase in vertebral displacement, normalized hemorrhage volume increased by 1.9 • 10 -3 mm 3 ( p = 0.028) and normalized area of axonal injury increased by 2.2 • 10 -1 mm 2 ( p < 0.001). Normalized hemorrhage volume was 3.3 • 10 -3 mm 3 greater for infants than for adults ( p < 0.001). Magnitude of dislocation was found to have a different effect on the normalized area of axonal injury in adults than in infants ( p = 0.003). Speed of dislocation was not found to have a significant effect on normalized hemorrhage volume ( p = 0.427) or normalized area of axonal injury ( p = 0.726) independent of displacement for the range of speeds tested. The findings of this study suggest that both age and amount of spinal motion are key factors in the severity of acute SCI.

The diaphragm is innervated by cervical nerves C3 to C5, but a patient may be able to mobilize the diaphragm with only partial innervation of the diaphragm. Testing diaphragm function may be accomplished with the "sniff test" of diaphragm elevation under fluoroscopy. Further, electrodiagnostic testing of phrenic nerve function also may be used to show a response in diaphragm function. Diaphragm pacing has been shown to be an effective way of weaning and maintaining patients off of mechanical ventilation, thus lowering the care burden, and liberating the patient to be more mobile, and lessening the potential for morbidity.

Respiratory complications are a leading cause of morbidity and mortality in patients with spinal cord injury. Several techniques, currently available or in development, have the capacity to restore respiratory muscle function allowing these patients to live more normal lives and hopefully reduce the incidence of respiratory complications. Bilateral phrenic nerve pacing, a clinically accepted technique to restore inspiratory muscle function, allows patients with ventilator dependent tetraplegia complete freedom from mechanical ventilation. Compared to mechanical ventilation, phrenic nerve pacing provides patients with increased mobility, improved speech, improved comfort level and reduction in health care costs. The results of clinical trials of laparoscopically placed intramuscular diaphragm electrodes suggest that diaphragm pacing can also be achieved without the need for a thoracotomy and associated long hospital stay, and without manipulation of the phrenic nerve which carries a risk of phrenic nerve injury. Other clinical trials are being performed to restore inspiratory intercostal function. In patients with only unilateral phrenic nerve function who are not candidates for phrenic nerve pacing, combined intercostal and unilateral diaphragm pacing appears to provide benefits similar to that of bilateral diaphragm pacing. Clinical trials are also underway to restore expiratory muscle function. Magnetic stimulation, surface stimulation and spinal cord stimulation of the expiratory muscles are promising techniques to restore an effective cough mechanism in this patient population. These techniques hold promise to reduce the incidence of respiratory tract infections, atelectasis and respiratory failure in patients with spinal cord injury and reduce the morbidity and mortality associated with these complications.

Introduction: The aim of the present study was to describe the pre hospital care of Traumatic Spinal Cord injuries (TSI), in particular the initial clinical presentation, the method of handling the victims and their transportation to the Douala General Hospital (DGH) or Douala Laquintinie Hospital (DLH). Method: Over a period of 5 months from January to May 2013, a prospective study was done at the DGH and DLH. Were included all patients victims of TSI and were excluded those with non traumatic spinal cord damage. Results: During the period of the study, 31 patients were recruited including 25 men (80.6%) and 6 women (19.4%). The mean age of patients was 37.0±17 years. About 51.6% of TSI were due to road traffic accident. For all the patients, no clinical examination was realized at the site of accident. All patients were carried out by inadequate procedure and Taxi was the most common mode of transportation of the patients (58.1%). The majority of patients (67.7%) had been taken to...

Study design: This cross-sectional chart review study included 100 US Veterans with spinal cord injuries/disorders (SCI/D) who received care at a Veterans Affairs (VA) SCI facility during a 12-month period. Progress notes were examined to extract need for weight management (WM), patient-provider discussions about risk due to overweight/obesity, recommended lifestyle changes and/or follow-up and WM education. Objectives: To understand what WM services are offered to Veterans with SCI/D within the VA SCI System of Care during comprehensive preventive health evaluations (annual evaluations), inpatient stays and outpatient visits. Setting: VA SCI System of Care, Department of Veterans Affairs, United States. Results: Overall, 73% demonstrated a need for WM. Weight was most frequently addressed during the nutrition assessment of annual evaluations, but this assessment was most likely to be skipped. Nutrition histories were missing many key components. Over half received WM education; individuals who were described as overweight/obese by their provider were more likely to receive education. Most of the Veterans who were seen in an inpatient setting were weighed; weight was only discussed with 12%. Less than half of the Veterans with outpatient visits were weighed, and 23% received WM recommendations. Conclusions: Weight was frequently discussed during nutrition assessments, but infrequently addressed during outpatient or inpatient encounters. Few Veterans received specific recommendations on caloric/nutrient requirements and nutrition histories were missing recommended elements. Additional work is needed to help providers to incorporate WM information into care.

High-force pneumatic muscle actuators (PMAs) are used for force assistance with minimal displacement applications. However, poor control due to dynamic nonlinearities has limited PMA applications. A simulated control system is developed consisting of: (1) a controller relating an input position angle to an output proportional pressure regulator voltage, (2) a phenomenological model of the PMA with an internal dynamic force loop (system time constant information), (3) a physical model of a human sit-to-stand task and (4) an external position angle feed-back loop. The results indicate that PMA assistance regarding the human sit-to-stand task is feasible within a specified PMA operational pressure range.

Respiratory dysfunction after cervical spinal cord injury (SCI) has not been examined experimentally using conscious animals, although clinical SCI most frequently occurs in midcervical segments. Here, we report a C5 hemicontusion SCI model in rats with abnormalities that emulate human post-SCI pathophysiology, including spontaneous recovery processes. Post-C5 SCI rats demonstrated deficits in minute ventilation (Ve) responses to a 7% CO2 challenge that correlated significantly with lesion severities (no injury or 12.5, 25, or 50 mm x 10 g weight drop; New York University impactor; p &lt; 0.001) and ipsilateral motor neuron loss (p = 0.016). Importantly, C5 SCI resulted in at least 4 weeks of respiratory abnormalities that ultimately recovered afterward. Because serotonin is involved in respiration-related neuroplasticity, we investigated the impact of activating 5-HT1A receptors on post-C5 SCI respiratory dysfunction. Treatment with the 5-HT1A agonist 8-hydroxy-2-(di-n-propylmino)t...

We investigated whether permeability transition-mediated release of mitochondrial cytochrome c is a potential therapeutic target for treating acute spinal cord injury (SCI). Based on previous reports, minocycline, a second-generation tetracycline, exerts neuroprotection partially by inhibiting mitochondrial cytochrome c release and reactive microgliosis. We first evaluated cytochrome c release at the injury epicenter after a T10 contusive SCI in rats. Cytochrome c release peaked at ≈4-8 h postinjury. A dose-response study generated a safe pharmacological regimen that enabled i.p. minocycline to significantly lower cytosolic cytochrome c at the epicenter 4 h after SCI. In the long-term study, i.p. minocycline (90 mg/kg administered 1 h after SCI followed by 45 mg/kg administered every 12 h for 5 days) markedly enhanced long-term hind limb locomotion relative to that of controls. Coordinated motor function and hind limb reflex recoveries also were improved significantly. Histopatholog...

Airway protection and spinal precautions are competing concerns in the treatment of unconscious trauma patients. The placement of such patients in a lateral position may facilitate the acquisition of an adequate airway. However, trauma dogma dictates that patients should be transported in the supine position to minimize spinal movement. In this systematic review, we sought to answer the following question: Given an existing spinal injury, will changing a patient&#39;s position from supine to lateral increase the risk of neurological deterioration? The review protocol was published in the PROSPERO database (Reg. no. CRD42012001190). We performed literature searches in PubMed, Medline, EMBASE, the Cochrane Library, CINAHL and the British Nursing Index and included studies of traumatic spinal injury, lateral positioning and neurological deterioration. The search was updated prior to submission. Two researchers independently completed each step in the review process. We identified 1,164...

Spinal cord injury (SCI) is a major cause of disability, and at present, there is no universally accepted treatment. The functional decline following SCI is contributed to both direct mechanical injury and secondary pathophysiological mechanisms that are induced by the initial trauma. These mechanisms initially involve widespread haemorrhage at the site of injury and necrosis of central nervous system (CNS) cellular components. At later stages of injury, the cord is observed to display reactive gliosis. The actions of astrocytes as well as numerous other cells in this response create an environment that is highly nonpermissive to axonal regrowth. Also manifesting important effects is the immune system. The early recruitment of neutrophils and at later stages, macrophages to the site of insult cause exacerbation of injury. However, at more chronic stages, macrophages and recruited T helper cells may potentially be helpful by providing trophic support for neuronal and non-neuronal components of the injured CNS. Within this sea of injurious mechanisms, the oligodendrocytes appear to be highly vulnerable. At chronic stages of SCI, a large number of oligodendrocytes undergo apoptosis at sites that are distant to the vicinity of primary injury. This leads to denudement of axons and deterioration of their conductive abilities, which adds significantly to functional decline. By indulging into the molecular mechanisms that cause oligodendrocyte apoptosis and identifying potential targets for therapeutic intervention, the prevention of this apoptotic wave will be of tremendous value to individuals living with SCI.

Following spinal cord injury (SCI), the pathological sequelae which ensue through the secondary mechanisms of degeneration produce myelin deposits which are potent inhibitors of endogenous neuroregeneration. We have enhanced the immune‐mediated response following a hemisection lesion by immunizing adult C57Bl/6 female mice against the inhibitor of neurite outgrowth Nogo‐A(623–640) peptide. Moderate anti‐Nogo‐A(623–640) antibody titre levels were obtained by using Montanide as the adjuvant. However, this antibody response was not obtained using incomplete Freund&#39;s adjuvant (IFA). Significant benefit in locomotor performance was demonstrated only in animals which were vaccinated with IFA and not with Montanide. No further benefit could be demonstrated with the Nogo‐A(623–640) peptide beyond that seen for adjuvant alone. These data imply that generating antibodies against Nogo‐A(623–640) in vivo alone is not sufficient to enhance locomotor recovery and that subcutaneous injection o...

Objective: This exploratory study describes the problematic secondary health conditions among adults with a spinal cord injury (SCI) and the impact these health concerns have on social participation and daily life. Design: Cross-sectional survey design. Setting: A community-based rehabilitation program within the United States. Participants: Fifty-six adults (33 males and 23 females; age 18 to 73 [M = 39.4, SD = 12.7]) with SCI participating in the community-based rehabilitation program. Methods: Subjects identified the top five problematic secondary health conditions related to his/her SCI, belief about the impact these conditions have on social participation and daily life, and if they believed the secondary health condition(s) were avoidable. Results: The top problematic areas identified were bladder control, pain, bowel control, and pressure ulcers, and 73% felt these problems were unavoidable. In addition, more than 66% had each of these problems continuously during the last 12 months. When examining the impact of the problematic secondary health conditions, 75% identified that the primary problem had a significant impact on social participation and 64% identified it significantly impacted daily life. Conclusion: Although the majority of the participants were actively participating in a community-based rehabilitation wellness program, it appears that they thought engagement in social participation and daily life were negatively impacted by the secondary health conditions and unavoidable. The results suggested unfulfilled goals despite the emphasized efforts of medical providers to help manage the secondary conditions. Future research should examine why individuals with SCI still have a difficult time managing secondary health conditions.

This book is the latest incarnation of a text that was first published in 1984. It has been updated to include modern techniques such as minimally invasive surgery, the evolution of critical care as well as modern vascular techniques. It would appeal to a general surgeon in training but could prove a useful aide-mémoire to more senior surgeons. Although this book provides an excellent overview, the detail of subspecialties is limited. It is written principally for the American generalist and, as such, there are certain nuances that do not represent current best UK practice. This book is easy to read with excellent diagrams and photographs. There are suggested reading lists at the end of chapters but detailed references are lacking. Overall, this is a pleasant read with broad interest for the general surgeon.

Objectives: Cation Channel Spermia (CatSper) 1-4 are considered as a unique family of "sperm cation channels" and play an important role in the motility of the sperm and male fertility. The aim of this study was to compare and evaluate the effects of selenium (Se) and electrical stimulation (Es) on the expression of CatSper 1 and 2 genes in the spinal cord injury (SCI) rat model. The present experimental study was performed on 50 male Wistar rats. The animals were randomly divided into 5 groups of 10 which experienced SCI using an SCI impactor device. Forty-eight hours after injury, the Se group received Se for 6 consecutive days for 6 weeks, and Es was performed for 1 hour per day for 6 consecutive days during 6 weeks in the Es group. Finally, the real-time polymerase chain reaction (PCR) was performed for the expression of CatSper 1 and 2 genes, followed by using one-way ANOVA for the analysis of gene expression data. The results were considered statistically significant when P < 0.05. Results: Se treatment showed an increase in the relative expression of CatSper 1 and 2 genes compared to the control group, but this increase was higher for CatSper 2. Eventually, Es did not affect the relative intensity of CatSper 1 and 2 gene expression after SCI. Conclusions: Se, more than Es, could increase the relative intensity of CatSper1 and 2 expressions, and this increase was higher in CatSper2.

Expose prealable a la table ronde Sports et handicap des EPSiliades des 12, 13 et14 novembre 2010 a Paris. Il y est question de performances et de progres dont sont capables des personnes en situation de handicap, de leur motivation pour les activites physiques et sportives, de types d’activites pratiquees, d’adaptations et d’integration