451
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Mallory GW, Grahn PJ, Hachmann JT, Lujan JL, Lee KH. Optical stimulation for restoration of motor function after spinal cord injury. Mayo Clin Proc 2015; 90:300-7. [PMID: 25659246 PMCID: PMC4339262 DOI: 10.1016/j.mayocp.2014.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/03/2014] [Accepted: 12/05/2014] [Indexed: 12/31/2022]
Abstract
Spinal cord injury can be defined as a loss of communication between the brain and the body due to disrupted pathways within the spinal cord. Although many promising molecular strategies have emerged to reduce secondary injury and promote axonal regrowth, there is still no effective cure, and recovery of function remains limited. Functional electrical stimulation (FES) represents a strategy developed to restore motor function without the need for regenerating severed spinal pathways. Despite its technological success, however, FES has not been widely integrated into the lives of spinal cord injury survivors. In this review, we briefly discuss the limitations of existing FES technologies. Additionally, we discuss how optogenetics, a rapidly evolving technique used primarily to investigate select neuronal populations within the brain, may eventually be used to replace FES as a form of therapy for functional restoration after spinal cord injury.
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Affiliation(s)
- Grant W Mallory
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Peter J Grahn
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Jan T Hachmann
- School of Medicine, Heidelberg University, Neuenheimer Feld, Bergheim, Germany
| | - J Luis Lujan
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN.
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452
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What are the perspectives for ventilated tetraplegics? A French retrospective study of 108 patients with cervical spinal cord injury. Ann Phys Rehabil Med 2015; 58:74-7. [PMID: 25766088 DOI: 10.1016/j.rehab.2014.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 12/30/2014] [Accepted: 12/30/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Tetraplegic patients are often difficult to manage in intensive care units (ICU). The aim of our study was to calculate the incidence of patients in ICU with cervical spinal cord injury with special focus on tetraplegic patients on ventilation support and their future perspectives. MATERIALS AND METHODS This retrospective study included patients with cervical spinal cord injury in Upper Normandy, between 2002 and 2012. Data analyzed included age, sex, past medical history, date of onset of quadriplegia, level of neurological involvement, AIS grade, and ventilatory status. RESULTS One hundred and eight patients were included (49.0 ± 21.1 years). The most common etiology was fall (50 patients [46.3%]). Incidence was calculated at 12.7 per one million inhabitants. Tracheotomy was performed in 40.7% of patients. Long-term mechanical ventilation was required for 6.5%. At the end of the study, 9 patients (9.6%) were permanently hospitalized, 61 patients (64.9%) had returned home but none of the four ventilated patients had been discharged. CONCLUSION The conclusion of this work is that the future of highly tetraplegic patients is compromised, especially for those who remain reliant on mechanical ventilation.
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453
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Lemmens S, Brône B, Dooley D, Hendrix S, Geurts N. Alpha-adrenoceptor modulation in central nervous system trauma: pain, spasms, and paralysis--an unlucky triad. Med Res Rev 2014; 35:653-77. [PMID: 25546087 DOI: 10.1002/med.21337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Many researchers have attempted to pharmacologically modulate the adrenergic system to control locomotion, pain, and spasms after central nervous system (CNS) trauma, although such efforts have led to conflicting results. Despite this, multiple studies highlight that α-adrenoceptors (α-ARs) are promising therapeutic targets because in the CNS, they are involved in reactivity to stressors and regulation of locomotion, pain, and spasms. These functions can be activated by direct modulation of these receptors on neuronal networks in the brain and the spinal cord. In addition, these multifunctional receptors are also broadly expressed on immune cells. This suggests that they might play a key role in modulating immunological responses, which may be crucial in treating spinal cord injury and traumatic brain injury as both diseases are characterized by a strong inflammatory component. Reducing the proinflammatory response will create a more permissive environment for axon regeneration and may support neuromodulation in combination therapies. However, pharmacological interventions are hindered by adrenergic system complexity and the even more complicated anatomical and physiological changes in the CNS after trauma. This review is the first concise overview of the pros and cons of α-AR modulation in the context of CNS trauma.
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Affiliation(s)
- Stefanie Lemmens
- Department of Morphology, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Bert Brône
- Department of Physiology, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Dearbhaile Dooley
- Department of Morphology, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Sven Hendrix
- Department of Morphology, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Nathalie Geurts
- Department of Morphology, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
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454
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Yarrow JF, Conover CF, Beggs LA, Beck DT, Otzel DM, Balaez A, Combs SM, Miller JR, Ye F, Aguirre JI, Neuville KG, Williams AA, Conrad BP, Gregory CM, Wronski TJ, Bose PK, Borst SE. Testosterone dose dependently prevents bone and muscle loss in rodents after spinal cord injury. J Neurotrauma 2014; 31:834-45. [PMID: 24378197 DOI: 10.1089/neu.2013.3155] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Androgen administration protects against musculoskeletal deficits in models of sex-steroid deficiency and injury/disuse. It remains unknown, however, whether testosterone prevents bone loss accompanying spinal cord injury (SCI), a condition that results in a near universal occurrence of osteoporosis. Our primary purpose was to determine whether testosterone-enanthate (TE) attenuates hindlimb bone loss in a rodent moderate/severe contusion SCI model. Forty (n=10/group), 14 week old male Sprague-Dawley rats were randomized to receive: (1) Sham surgery (T9 laminectomy), (2) moderate/severe (250 kdyne) SCI, (3) SCI+Low-dose TE (2.0 mg/week), or (4) SCI+High-dose TE (7.0 mg/week). Twenty-one days post-injury, SCI animals exhibited a 77-85% reduction in hindlimb cancellous bone volume at the distal femur (measured via μCT) and proximal tibia (measured via histomorphometry), characterized by a >70% reduction in trabecular number, 13-27% reduction in trabecular thickness, and increased trabecular separation. A 57% reduction in cancellous volumetric bone mineral density (vBMD) at the distal femur and a 20% reduction in vBMD at the femoral neck were also observed. TE dose dependently prevented hindlimb bone loss after SCI, with high-dose TE fully preserving cancellous bone structural characteristics and vBMD at all skeletal sites examined. Animals receiving SCI also exhibited a 35% reduction in hindlimb weight bearing (triceps surae) muscle mass and a 22% reduction in sublesional non-weight bearing (levator ani/bulbocavernosus [LABC]) muscle mass, and reduced prostate mass. Both TE doses fully preserved LABC mass, while only high-dose TE ameliorated hindlimb muscle losses. TE also dose dependently increased prostate mass. Our findings provide the first evidence indicating that high-dose TE fully prevents hindlimb cancellous bone loss and concomitantly ameliorates muscle loss after SCI, while low-dose TE produces much less profound musculoskeletal benefit. Testosterone-induced prostate enlargement, however, represents a potential barrier to the clinical implementation of high-dose TE as a means of preserving musculoskeletal tissue after SCI.
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Affiliation(s)
- Joshua F Yarrow
- 1 VA Medical Center, Research Service, VA Medical Center , Gainesville, Florida
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455
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Post MWM. Definitions of quality of life: what has happened and how to move on. Top Spinal Cord Inj Rehabil 2014; 20:167-80. [PMID: 25484563 DOI: 10.1310/sci2003-167] [Citation(s) in RCA: 208] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Quality of life (QOL) is an important outcome in spinal cord injury (SCI) rehabilitation, but it is unclear how to define and measure it. OBJECTIVE The aims of this article are to (a) show how the concepts of QOL and health-related quality of life (HRQOL) have evolved over time, (b) describe the various ways QOL has been defined and measured, and (c) provide recommendations on how to be as clear and consistent as possible in QOL research. METHOD A narrative review of the QOL literature was performed. RESULTS Roots of the term "quality of life" in health care can be traced back to the definition of health by the World Health Organization in 1948. The use of the word "well-being" in this definition is probably a main factor in the continuing confusion about the conceptualization of QOL. Within the field of SCI rehabilitation, the Dijkers's QOL model, distinguishing between utilities, achievements, and subjective evaluations and reactions, has been very influential and the basis for several reviews and databases. Nevertheless, literature shows that it is still difficult to consistently use the term "quality of life" and categorize QOL measures. Several aspects of QOL that are specific for individuals with SCI have been identified. CONCLUSIONS Researchers should be as specific and clear as possible about the concept and operationalization of QOL in their studies. Readers should not take the term "quality of life" for granted, but should inspect the topic of the study from the actual measures used.
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Affiliation(s)
- Marcel W M Post
- Center of Excellence in Rehabilitation Medicine , De Hoogstraat, Utrecht, Netherlands
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456
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Melo Neto JSD, Tognola WA, Spotti AR, Morais DFD. Analysis of patients with spinal cord trauma associated with traumatic brain injury. COLUNA/COLUMNA 2014. [DOI: 10.1590/s1808-18512014130400459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: Characterize victims of spinal cord injury (SCI) associated with traumatic brain injury (TBI) and risk factors. Methods: Study conducted with 52 victims of SCI associated with TBI. The variables studied were: sex; age; marital status; occupation; educational level; religion; etiology and the lesion area; neurological condition by the ASIA scale; associated injuries and potential risk factors. Results: The male (85%), aged between 21-30 years (25%), civil status stable union (56%), low level of education (69%) and the Roman Catholic religion (77%) presented the greater number of victims. Motor vehicle accidents (58%) were the main etiology. The cervical segment had higher injury risk (RR=3.48, p<0.0001). The neurological status ASIA-E (52%), the syndromic neck pain (35%) and the rate of mild TBI (65%) were the most frequent. Complications occurred in 13 patients with increased frequency of pneumonia (62%). The length of hospital stay was significantly higher (20±28 days) and 17% of patients died. Men (RR=2.14, p=0.028) and individuals exposed to motor vehicle accidents (RR=1.91, p=0.022) showed a higher risk of these lesions concurrently. Moreover, these patients had 2.48 (p<0.01) higher risk of death than victims of SCI alone. Conclusion: The SCI associated with TBI was more frequent in men, young adults, and individuals exposed to motor vehicle accidents. The cervical spine is more likely to be affected. Furthermore, the length of hospitalization is significantly higher and the subjects analyzed have higher risk of death.
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Affiliation(s)
| | - Waldir Antônio Tognola
- Faculdade de Medicina de São José do Rio Preto (FAMERP), Brazil; Hospital de Base, Brazil
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457
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Margolis JM, Juneau P, Sadosky A, Cappelleri JC, Bryce TN, Nieshoff EC. Health Care Resource Utilization and Medical Costs of Spinal Cord Injury With Neuropathic Pain in a Commercially Insured Population in the United States. Arch Phys Med Rehabil 2014; 95:2279-87. [DOI: 10.1016/j.apmr.2014.07.416] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 07/18/2014] [Accepted: 07/30/2014] [Indexed: 11/29/2022]
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458
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Dvorak MF, Noonan VK, Fallah N, Fisher CG, Finkelstein J, Kwon BK, Rivers CS, Ahn H, Paquet J, Tsai EC, Townson A, Attabib N, Bailey CS, Christie SD, Drew B, Fourney DR, Fox R, Hurlbert RJ, Johnson MG, Linassi AG, Parent S, Fehlings MG. The influence of time from injury to surgery on motor recovery and length of hospital stay in acute traumatic spinal cord injury: an observational Canadian cohort study. J Neurotrauma 2014; 32:645-54. [PMID: 25333195 DOI: 10.1089/neu.2014.3632] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To determine the influence of time from injury to surgery on neurological recovery and length of stay (LOS) in an observational cohort of individuals with traumatic spinal cord injury (tSCI), we analyzed the baseline and follow-up motor scores of participants in the Rick Hansen Spinal Cord Injury Registry to specifically assess the effect of an early (less than 24 h from injury) surgical procedure on motor recovery and on LOS. One thousand four hundred and ten patients who sustained acute tSCIs with baseline American Spinal Injury Association Impairment Scale (AIS) grades A, B, C, or D and were treated surgically were analyzed to determine the effect of the timing of surgery (24, 48, or 72 h from injury) on motor recovery and LOS. Depending on the distribution of data, we used different types of generalized linear models, including multiple linear regression, gamma regression, and negative binomial regression. Persons with incomplete AIS B, C, and D injuries from C2 to L2 demonstrated motor recovery improvement of an additional 6.3 motor points (SE=2.8 p<0.03) when they underwent surgical treatment within 24 h from the time of injury, compared with those who had surgery later than 24 h post-injury. This beneficial effect of early surgery on motor recovery was not seen in the patients with AIS A complete SCI. AIS A and B patients who received early surgery experienced shorter hospital LOS. While the issues of when to perform surgery and what specific operation to perform remain controversial, this work provides evidence that for an incomplete acute tSCI in the cervical, thoracic, or thoracolumbar spine, surgery performed within 24 h from injury improves motor neurological recovery. Early surgery also reduces LOS.
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Affiliation(s)
- Marcel F Dvorak
- 1 Division of Spine, Department of Orthopedics, University of British Columbia , Vancouver, British Columbia, Canada
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459
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Incidence of traumatic spinal cord injury in Denmark, 1990–2012: a hospital-based study. Spinal Cord 2014; 53:436-40. [DOI: 10.1038/sc.2014.181] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 09/23/2014] [Accepted: 09/28/2014] [Indexed: 11/09/2022]
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460
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Fyffe DC, Deutsch A, Botticello AL, Kirshblum S, Ottenbacher KJ. Racial and ethnic disparities in functioning at discharge and follow-up among patients with motor complete spinal cord injury. Arch Phys Med Rehabil 2014; 95:2140-51. [PMID: 25093999 PMCID: PMC4374601 DOI: 10.1016/j.apmr.2014.07.398] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine racial and ethnic differences in self-care and mobility outcomes for persons with a motor complete, traumatic spinal cord injury (SCI) at discharge and 1-year follow-up. DESIGN Retrospective cohort study. SETTING Sixteen rehabilitation centers contributing to the Spinal Cord Injury Model Systems (SCIMS) database. PARTICIPANTS Adults with traumatic, motor complete SCI (N=1766; American Spinal Injury Association Impairment Scale grade A or B) enrolled in the SCIMS between 2000 and 2011. Selected cases had complete self-reported data on race and ethnicity (non-Hispanic white, non-Hispanic black, or Hispanic) and motor FIM scores assessed at inpatient rehabilitation admission, discharge, and 1-year follow-up. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Functional outcomes were measured by FIM self-care and mobility scores on a 1 to 7 FIM scale, at discharge and 1-year follow-up. RESULTS Multiple regression models stratified by neurologic category and adjusted for sociodemographic and injury characteristics assessed racial and ethnic group differences in FIM self-care and mobility change scores at discharge and 1-year follow-up. At discharge, non-Hispanic black participants with tetraplegia and paraplegia had significantly poorer gains in FIM self-care and mobility scores relative to non-Hispanic white and Hispanic participants. At 1-year follow-up, similar FIM self-care and mobility change scores were found across racial and ethnic groups within each neurologic category. CONCLUSIONS Non-Hispanic white and Hispanic participants had comparatively more improvement in self-care and mobility during inpatient rehabilitation compared with non-Hispanic black participants. At 1-year follow-up, no differences in self-care and mobility outcomes were observed across racial and ethnic groups. Additional research is needed to identify potential modifiable factors that may contribute to racially and ethnically different patterns of functional outcomes observed during inpatient rehabilitation.
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Affiliation(s)
- Denise C Fyffe
- Kessler Foundation, West Orange, NJ; New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ.
| | - Anne Deutsch
- Rehabilitation Institute of Chicago, Chicago, IL; Research Triangle Institute International, Research Triangle Park, NC
| | - Amanda L Botticello
- Kessler Foundation, West Orange, NJ; New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ
| | - Steven Kirshblum
- Kessler Foundation, West Orange, NJ; New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ; Kessler Institute for Rehabilitation, West Orange, NJ
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461
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Van Toen C, Street J, Oxland TR, Cripton PA. Cervical spine injuries and flexibilities following axial impact with lateral eccentricity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:136-47. [PMID: 25344091 DOI: 10.1007/s00586-014-3612-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 09/30/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Determine the effects of dynamic injurious axial compression applied at various lateral eccentricities (lateral distance to the centre of the spine) on mechanical flexibilities and structural injury patterns of the cervical spine. METHODS 13 three-vertebra human cadaver cervical spine specimens (6 C3-5, 3 C4-6, 2 C5-7, 2 C6-T1) were subjected to pure moment flexibility tests (±1.5 Nm) before and after impact trauma was applied in two groups: low and high lateral eccentricity (1 and 150 % of the lateral diameter of the vertebral body, respectively). Relative range of motion (ROM) and relative neutral zone (NZ) were calculated as the ratio of post and pre-trauma values. Injuries were diagnosed by a spine surgeon and scored. Classification functions were developed using discriminant analysis. RESULTS Low and high eccentric loading resulted in primarily bony fractures and soft tissue injuries, respectively. Axial impacts with high lateral eccentricities resulted in greater spinal motion in lateral bending [median relative ROM 3.5 (interquartile range, IQR 2.3) vs. 1.4 (IQR 0.5) and median relative NZ 4.7 (IQR 3.7) vs. 2.3 (IQR 1.1)] and in axial rotation [median relative ROM 5.3 (IQR 13.7) vs. 1.3 (IQR 0.5), p < 0.05 for all comparisons] than those that resulted from low eccentricity impacts. The developed classification functions had 92 % classification accuracy. CONCLUSIONS Dynamic axial compression loading of the cervical spine with high lateral eccentricities produced primarily soft tissue injuries resulting in more post-injury spinal flexibility in lateral bending and axial rotation than that associated with the bony fractures resulting from low eccentricity impacts.
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Affiliation(s)
- C Van Toen
- Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics, University of British Columbia, 6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada
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462
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Fagoe ND, van Heest J, Verhaagen J. Spinal cord injury and the neuron-intrinsic regeneration-associated gene program. Neuromolecular Med 2014; 16:799-813. [PMID: 25269879 DOI: 10.1007/s12017-014-8329-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/20/2014] [Indexed: 12/14/2022]
Abstract
Spinal cord injury (SCI) affects millions of people worldwide and causes a significant physical, emotional, social and economic burden. The main clinical hallmark of SCI is the permanent loss of motor, sensory and autonomic function below the level of injury. In general, neurons of the central nervous system (CNS) are incapable of regeneration, whereas injury to the peripheral nervous system is followed by axonal regeneration and usually results in some degree of functional recovery. The weak neuron-intrinsic regeneration-associated gene (RAG) response upon injury is an important reason for the failure of neurons in the CNS to regenerate an axon. This response consists of the expression of many RAGs, including regeneration-associated transcription factors (TFs). Regeneration-associated TFs are potential key regulators of the RAG program. The function of some regeneration-associated TFs has been studied in transgenic and knock-out mice and by adeno-associated viral vector-mediated overexpression in injured neurons. Here, we review these studies and propose that AAV-mediated gene delivery of combinations of regeneration-associated TFs is a potential strategy to activate the RAG program in injured CNS neurons and achieve long-distance axon regeneration.
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Affiliation(s)
- Nitish D Fagoe
- Laboratory for Neuroregeneration, Netherlands Institute for Neuroscience, an Institute of the Royal Academy of Arts and Sciences, Meibergdreef 47, 1105 BA, Amsterdam, The Netherlands,
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463
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Grahn PJ, Mallory GW, Berry BM, Hachmann JT, Lobel DA, Lujan JL. Restoration of motor function following spinal cord injury via optimal control of intraspinal microstimulation: toward a next generation closed-loop neural prosthesis. Front Neurosci 2014; 8:296. [PMID: 25278830 PMCID: PMC4166363 DOI: 10.3389/fnins.2014.00296] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 08/31/2014] [Indexed: 11/13/2022] Open
Abstract
Movement is planned and coordinated by the brain and carried out by contracting muscles acting on specific joints. Motor commands initiated in the brain travel through descending pathways in the spinal cord to effector motor neurons before reaching target muscles. Damage to these pathways by spinal cord injury (SCI) can result in paralysis below the injury level. However, the planning and coordination centers of the brain, as well as peripheral nerves and the muscles that they act upon, remain functional. Neuroprosthetic devices can restore motor function following SCI by direct electrical stimulation of the neuromuscular system. Unfortunately, conventional neuroprosthetic techniques are limited by a myriad of factors that include, but are not limited to, a lack of characterization of non-linear input/output system dynamics, mechanical coupling, limited number of degrees of freedom, high power consumption, large device size, and rapid onset of muscle fatigue. Wireless multi-channel closed-loop neuroprostheses that integrate command signals from the brain with sensor-based feedback from the environment and the system's state offer the possibility of increasing device performance, ultimately improving quality of life for people with SCI. In this manuscript, we review neuroprosthetic technology for improving functional restoration following SCI and describe brain-machine interfaces suitable for control of neuroprosthetic systems with multiple degrees of freedom. Additionally, we discuss novel stimulation paradigms that can improve synergy with higher planning centers and improve fatigue-resistant activation of paralyzed muscles. In the near future, integration of these technologies will provide SCI survivors with versatile closed-loop neuroprosthetic systems for restoring function to paralyzed muscles.
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Affiliation(s)
- Peter J. Grahn
- Mayo Clinic College of Medicine, Mayo ClinicRochester, MN, USA
| | | | | | - Jan T. Hachmann
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
| | | | - J. Luis Lujan
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo ClinicRochester, MN, USA
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464
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New PW, Baxter D, Farry A, Noonan VK. Estimating the incidence and prevalence of traumatic spinal cord injury in Australia. Arch Phys Med Rehabil 2014; 96:76-83. [PMID: 25218255 DOI: 10.1016/j.apmr.2014.08.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/10/2014] [Accepted: 08/12/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine estimates of the incidence and prevalence of traumatic spinal cord injury (TSCI) in Australia as of June 30, 2011. DESIGN Population modeling using cohort survival. SETTING Australia. PARTICIPANTS Hospital data regarding people with TSCI in Australia. INTERVENTIONS Modeling using the following data: 2 population-based databases of hospital separations of patients with TSCI, giving upper and lower estimates of incidence; national population profiles and life tables; levels of TSCI based on Australian Spinal Cord Injury Registry; and life expectancy for persons with spinal cord injury under 3 scenarios--1 constant and 2 with a trend standardized mortality ratio (SMR). MAIN OUTCOME MEASURES Age- and sex-specific incidence and prevalence estimates. RESULTS The lower estimate of incidence was 21.0 per million population per year, and the upper estimate was 32.3 per million population per year. The derived prevalence rates ranged from 490 per million population (10,944 persons--lower incidence, trend SMR with survival from 1948) up to 886 per million population (19,784 persons--higher incidence, constant SMR). The prevalence was highest in males, persons aged 46 to 60 years, and those with tetraplegia. CONCLUSIONS We have reported a method for calculating an estimate of the prevalence of TSCI which provides information that will be vital to optimize health care planning for this group of highly disabled members of society.
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Affiliation(s)
- Peter Wayne New
- Spinal Rehabilitation Unit, Rehabilitation Services, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia; Epworth-Monash Rehabilitation Medicine Unit, Southern Medical School, Monash University, Melbourne, Victoria, Australia.
| | - David Baxter
- Urban Futures Institute, Vancouver, British Columbia, Canada
| | - Angela Farry
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Vanessa K Noonan
- Rick Hansen Institute, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
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465
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Selvarajah S, Schneider EB, Becker D, Sadowsky CL, Haider AH, Hammond ER. The Epidemiology of Childhood and Adolescent Traumatic Spinal Cord Injury in the United States: 2007–2010. J Neurotrauma 2014; 31:1548-60. [DOI: 10.1089/neu.2014.3332] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shalini Selvarajah
- Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric B. Schneider
- Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel Becker
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland
- International Neurorehabilitation Institute, Lutherville, Maryland
| | - Cristina L. Sadowsky
- International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, Maryland
| | - Adil H. Haider
- Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Acute Care Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edward R. Hammond
- International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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466
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Abstract
Neurotrauma continues to be a significant cause of morbidity and mortality. Prevention of primary neurologic injury is a critical public health concern. Early and thorough assessment of the patient with neurotrauma with high index of suspicion of traumatic spinal cord injuries and traumatic vascular injuries requires a multidisciplinary approach involving prehospital providers, emergency physicians, neurosurgeons, and neurointensivists. Critical care management of the patient with neurotrauma is focused on the prevention of secondary injuries. Much research is still needed for potential neuroprotection therapies.
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Affiliation(s)
- Wan-Tsu W Chang
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA
| | - Neeraj Badjatia
- Department of Neurology, University of Maryland School of Medicine, 110 South Paca Street, 3rd Floor, 072, Baltimore, MD 21201, USA; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA.
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467
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Centralized spinal cord injury care in Finland: unveiling the hidden incidence of traumatic injuries. Spinal Cord 2014; 52:779-84. [DOI: 10.1038/sc.2014.131] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/28/2014] [Accepted: 07/08/2014] [Indexed: 11/08/2022]
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468
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Xia X, Qu B, Ma Y, Yang LB, Huang HD, Cheng JM, Yang T, Kong B, Liu EY, Zhao K, He WQ, Xing XM, Liang L, Fan KX, Sun HD, Zhou HT, Cheng L, Gu JW, Kuang YQ. Analyzing time-series microarray data reveals key genes in spinal cord injury. Mol Biol Rep 2014; 41:6827-35. [PMID: 25063577 DOI: 10.1007/s11033-014-3568-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 06/25/2014] [Indexed: 02/06/2023]
Abstract
Although many scholars have utilized high-throughput microarrays to delineate gene expression patterns after spinal cord injury (SCI), no study has evaluated gene changes in raphe magnus (RM) and somatomotor cortex (SMTC), two areas in brain primarily affected by SCI. In present study, we aimed to analyze the differentially expressed genes (DEGs) of RM and SMTC between SCI model and sham injured control at 4, 24 h, 7, 14, 28 days, and 3 months using microarray dataset GSE2270 downloaded from gene expression omnibus and unpaired significance analysis of microarray method. Protein-protein interaction (PPI) network was constructed for DEGs at crucial time points and significant biological functions were enriched using DAVID. The results indicated that more DEGs were identified at 14 days in RM and at 4 h/3 months in SMTC after SCI. In the PPI network for DEGs at 14 days in RM, interleukin 6, glyceraldehyde-3-phosphate dehydrogenase (GAPDH), FBJ murine osteosarcoma viral oncogene homolog (FOS), tumor necrosis factor, and nuclear receptor subfamily 3, group C, member 1 (glucocorticoid receptor) were the top 5 hub genes; In the PPI network for DEGs at 3 months in SMTC, the top 5 hub genes were ubiquitin B, Ras-related C3 botulinum toxin substrate 1 (rho family, small GTP binding protein Rac1), FOS, Janus kinase 2 and vascular endothelial growth factor A. Hedgehog and Wnt signaling pathways were the top 2 significant pathways in RM. These hub DEGs and pathways may be underlying therapeutic targets for SCI.
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Affiliation(s)
- Xun Xia
- Department of Neurosurgery, Chengdu Military General Hospital, No. 270 Rongdu Road, Chengdu, 610083, Sichuan, People's Republic of China
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469
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Inducible protein-10, a potential driver of neurally controlled interleukin-10 and morbidity in human blunt trauma. Crit Care Med 2014; 42:1487-97. [PMID: 24584064 DOI: 10.1097/ccm.0000000000000248] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Blunt trauma and traumatic spinal cord injury induce systemic inflammation that contributes to morbidity. Dysregulated neural control of systemic inflammation postinjury is likely exaggerated in patients with traumatic spinal cord injury. We used in silico methods to discern dynamic inflammatory networks that could distinguish systemic inflammation in traumatic spinal cord injury from blunt trauma. DESIGN Retrospective study. SETTINGS Tertiary care institution. PATIENTS Twenty-one severely injured thoracocervical traumatic spinal cord injury patients and matched 21 severely injured blunt trauma patients without spinal cord injury. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Serial blood samples were obtained from days 1 to 14 postinjury. Twenty-four plasma inflammatory mediators were quantified. Statistical significance between the two groups was determined by two-way analysis of variance. Dynamic Bayesian network inference was used to suggest dynamic connectivity and central inflammatory mediators. Circulating interleukin-10 was significantly elevated in thoracocervical traumatic spinal cord injury group versus non-spinal cord injury group, whereas interleukin-1β, soluble interleukin-2 receptor-α, interleukin-4, interleukin-5, interleukin-7, interleukin-13, interleukin-17, macrophage inflammatory protein 1α and 1β, granulocyte-macrophage colony-stimulating factor, and interferon-γ were significantly reduced in traumatic spinal cord injury group versus non-spinal cord injury group. Dynamic Bayesian network suggested that post-spinal cord injury interleukin-10 is driven by inducible protein-10, whereas monocyte chemotactic protein-1 was central in non-spinal cord injury dynamic networks. In a separate validation cohorts of 356 patients without spinal cord injury and 85 traumatic spinal cord injury patients, individuals with plasma inducible protein-10 levels more than or equal to 730 pg/mL had significantly prolonged hospital and ICU stay and days on mechanical ventilator versus patients with plasma inducible protein-10 level less than 730 pg/mL. CONCLUSION This is the first study to compare the dynamic systemic inflammatory responses of traumatic spinal cord injury patients versus patients without spinal cord injury, suggesting a key role for inducible protein-10 in driving systemic interleukin-10 and morbidity and highlighting the potential utility of in silico tools to identify key inflammatory drivers.
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470
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Korhonen N, Kannus P, Niemi S, Parkkari J, Sievänen H. Rapid increase in fall-induced cervical spine injuries among older Finnish adults between 1970 and 2011. Age Ageing 2014; 43:567-71. [PMID: 24865165 DOI: 10.1093/ageing/afu060] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND fall-related injuries in older adults are a major public heath challenge. METHODS we determined the current trends in the number and age-adjusted incidence of fall-induced severe cervical spine injuries among older adults in Finland by taking into account all persons in 50 years of age or older who were admitted to Finnish hospitals for primary treatment of these injuries between 1970 and 2011. Similar patients aged 20-49 years served as a reference group. RESULTS the number of fall-induced cervical spine injuries among older Finns rose six-fold from 59 in 1970 to 372 in 2011. The age-adjusted incidence of injury (per 100 000 persons) was higher in men than in women throughout this period and showed a clear increase from 1970 to 2011: from 8.5 to 20.3 in men, and from 2.8 to 11.7 in women. In both sexes, the increase was most prominent in the oldest age group, persons aged 70 years or older. In the reference group, the injury incidence did not rise by time. CONCLUSIONS the number and incidence of fall-induced severe cervical spine injuries among older Finns increased considerably between 1970 and 2011. An increase in the average risk of serious falls may partly explain the phenomenon. Wide-scale fall and injury prevention measures are urgently needed, because further ageing of the population is likely to worsen the problem in the near future.
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Affiliation(s)
- Niina Korhonen
- Injury and Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Pekka Kannus
- Injury and Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Seppo Niemi
- Injury and Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Jari Parkkari
- Tampere Research Center of Sports Medicine, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Harri Sievänen
- Injury and Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland
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471
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Carmel JB, Martin JH. Motor cortex electrical stimulation augments sprouting of the corticospinal tract and promotes recovery of motor function. Front Integr Neurosci 2014; 8:51. [PMID: 24994971 PMCID: PMC4061747 DOI: 10.3389/fnint.2014.00051] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/28/2014] [Indexed: 12/11/2022] Open
Abstract
The corticospinal system—with its direct spinal pathway, the corticospinal tract (CST) – is the primary system for controlling voluntary movement. Our approach to CST repair after injury in mature animals was informed by our finding that activity drives establishment of connections with spinal cord circuits during postnatal development. After incomplete injury in maturity, spared CST circuits sprout, and partially restore lost function. Our approach harnesses activity to augment this injury-dependent CST sprouting and to promote function. Lesion of the medullary pyramid unilaterally eliminates all CST axons from one hemisphere and allows examination of CST sprouting from the unaffected hemisphere. We discovered that 10 days of electrical stimulation of either the spared CST or motor cortex induces CST axon sprouting that partially reconstructs the lost CST. Stimulation also leads to sprouting of the cortical projection to the magnocellular red nucleus, where the rubrospinal tract originates. Coordinated outgrowth of the CST and cortical projections to the red nucleus could support partial re-establishment of motor systems connections to the denervated spinal motor circuits. Stimulation restores skilled motor function in our animal model. Lesioned animals have a persistent forelimb deficit contralateral to pyramidotomy in the horizontal ladder task. Rats that received motor cortex stimulation either after acute or chronic injury showed a significant functional improvement that brought error rate to pre-lesion control levels. Reversible inactivation of the stimulated motor cortex reinstated the impairment demonstrating the importance of the stimulated system to recovery. Motor cortex electrical stimulation is an effective approach to promote spouting of spared CST axons. By optimizing activity-dependent sprouting in animals, we could have an approach that can be translated to the human for evaluation with minimal delay.
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Affiliation(s)
- Jason B Carmel
- Department of Neurology, Weill Cornell Medical College New York, NY, USA ; Department of Pediatrics, Weill Cornell Medical College New York, NY, USA ; Brain and Mind Research Institute, Weill Cornell Medical College New York, NY, USA ; Burke Medical Research Institute White Plains, NY, USA
| | - John H Martin
- Department of Physiology, Pharmacology and Neuroscience, City College of the City University of New York New York, NY, USA
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472
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Data-driven, evidenced-based, computational modeling research is still needed in trauma research. Crit Care Med 2014; 42:1566-7. [PMID: 24836802 DOI: 10.1097/ccm.0000000000000269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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473
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Relationship between stroke volume and pulse pressure during blood volume perturbation: a mathematical analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:459269. [PMID: 25006577 PMCID: PMC4054969 DOI: 10.1155/2014/459269] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/15/2014] [Accepted: 04/24/2014] [Indexed: 12/13/2022]
Abstract
Arterial pulse pressure has been widely used as surrogate of stroke volume, for example, in the guidance of fluid therapy. However, recent experimental investigations suggest that arterial pulse pressure is not linearly proportional to stroke volume. However, mechanisms underlying the relation between the two have not been clearly understood. The goal of this study was to elucidate how arterial pulse pressure and stroke volume respond to a perturbation in the left ventricular blood volume based on a systematic mathematical analysis. Both our mathematical analysis and experimental data showed that the relative change in arterial pulse pressure due to a left ventricular blood volume perturbation was consistently smaller than the corresponding relative change in stroke volume, due to the nonlinear left ventricular pressure-volume relation during diastole that reduces the sensitivity of arterial pulse pressure to perturbations in the left ventricular blood volume. Therefore, arterial pulse pressure must be used with care when used as surrogate of stroke volume in guiding fluid therapy.
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474
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Zimmermann JB, Jackson A. Closed-loop control of spinal cord stimulation to restore hand function after paralysis. Front Neurosci 2014; 8:87. [PMID: 24904251 PMCID: PMC4032985 DOI: 10.3389/fnins.2014.00087] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/07/2014] [Indexed: 12/28/2022] Open
Abstract
As yet, no cure exists for upper-limb paralysis resulting from the damage to motor pathways after spinal cord injury or stroke. Recently, neural activity from the motor cortex of paralyzed individuals has been used to control the movements of a robot arm but restoring function to patients' actual limbs remains a considerable challenge. Previously we have shown that electrical stimulation of the cervical spinal cord in anesthetized monkeys can elicit functional upper-limb movements like reaching and grasping. Here we show that stimulation can be controlled using cortical activity in awake animals to bypass disruption of the corticospinal system, restoring their ability to perform a simple upper-limb task. Monkeys were trained to grasp and pull a spring-loaded handle. After temporary paralysis of the hand was induced by reversible inactivation of primary motor cortex using muscimol, grasp-related single-unit activity from the ventral premotor cortex was converted into stimulation patterns delivered in real-time to the cervical spinal gray matter. During periods of closed-loop stimulation, task-modulated electromyogram, movement amplitude, and task success rate were improved relative to interleaved control periods without stimulation. In some sessions, single motor unit activity from weakly active muscles was also used successfully to control stimulation. These results are the first use of a neural prosthesis to improve the hand function of primates after motor cortex disruption, and demonstrate the potential for closed-loop cortical control of spinal cord stimulation to reanimate paralyzed limbs.
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Affiliation(s)
- Jonas B Zimmermann
- Faculty of Medical Sciences, Institute of Neuroscience, Newcastle University Newcastle Upon Tyne, UK ; Donoghue Lab, Department of Neuroscience, Brown University Providence, RI, USA
| | - Andrew Jackson
- Faculty of Medical Sciences, Institute of Neuroscience, Newcastle University Newcastle Upon Tyne, UK
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475
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Menezes K, Nascimento MA, Gonçalves JP, Cruz AS, Lopes DV, Curzio B, Bonamino M, de Menezes JRL, Borojevic R, Rossi MID, Coelho-Sampaio T. Human mesenchymal cells from adipose tissue deposit laminin and promote regeneration of injured spinal cord in rats. PLoS One 2014; 9:e96020. [PMID: 24830794 PMCID: PMC4022508 DOI: 10.1371/journal.pone.0096020] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/03/2014] [Indexed: 12/18/2022] Open
Abstract
Cell therapy is a promising strategy to pursue the unmet need for treatment of spinal cord injury (SCI). Although several studies have shown that adult mesenchymal cells contribute to improve the outcomes of SCI, a description of the pro-regenerative events triggered by these cells is still lacking. Here we investigated the regenerative properties of human adipose tissue derived stromal cells (hADSCs) in a rat model of spinal cord compression. Cells were delivered directly into the spinal parenchyma immediately after injury. Human ADSCs promoted functional recovery, tissue preservation, and axonal regeneration. Analysis of the cord tissue showed an abundant deposition of laminin of human origin at the lesion site and spinal midline; the appearance of cell clusters composed of neural precursors in the areas of laminin deposition, and the appearance of blood vessels with separated basement membranes along the spinal axis. These effects were also observed after injection of hADSCs into non-injured spinal cord. Considering that laminin is a well-known inducer of axonal growth, as well a component of the extracellular matrix associated to neural progenitors, we propose that it can be the paracrine factor mediating the pro-regenerative effects of hADSCs in spinal cord injury.
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Affiliation(s)
- Karla Menezes
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcos Assis Nascimento
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juliana Pena Gonçalves
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aline Silva Cruz
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daiana Vieira Lopes
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bianca Curzio
- National Institute of Cancer, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Martin Bonamino
- National Institute of Cancer, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Maria Isabel Doria Rossi
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tatiana Coelho-Sampaio
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
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476
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Dural tear and resultant cerebrospinal fluid leaks after cervical spinal trauma. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:1772-6. [DOI: 10.1007/s00586-014-3332-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 04/23/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
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477
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Botticello AL, Rohrbach T, Cobbold N. Disability and the built environment: an investigation of community and neighborhood land uses and participation for physically impaired adults. Ann Epidemiol 2014; 24:545-50. [PMID: 24935467 DOI: 10.1016/j.annepidem.2014.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/21/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE There is a need for empirical support of the association between the built environment and disability-related outcomes. This study explores the associations between community and neighborhood land uses and community participation among adults with acquired physical disability. METHODS Cross-sectional data from 508 community-living chronically disabled adults in New Jersey were obtained from among participants in national Spinal Cord Injury Model Systems database. Participants' residential addresses were geocoded to link individual survey data with Geographic Information Systems data on land use and destinations. The influence of residential density, land use mix, destination counts, and open space on four domains of participation were modeled at two geographic scales-the neighborhood (i.e., half mile buffer) and community (i.e., five mile) using multivariate logistic regression. All analyses were adjusted for demographic- and impairment-related differences. RESULTS Living in communities with greater land use mix and more destinations was associated with a decreased likelihood of reporting optimum social and physical activity. Conversely, living in neighborhoods with large portions of open space was positively associated with the likelihood of reporting full physical, occupational, and social participation. CONCLUSIONS These findings suggest that the overall living conditions of the built environment may be relevant to social inclusion for persons with physical disabilities.
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Affiliation(s)
- Amanda L Botticello
- Outcomes and Assessment Department, Kessler Foundation Research Center, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark.
| | - Tanya Rohrbach
- Department of Science and Engineering, Raritan Valley Community College, Branchburg, NJ
| | - Nicolette Cobbold
- Outcomes and Assessment Department, Kessler Foundation Research Center, West Orange, NJ
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478
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Forrest GF, Hutchinson K, Lorenz DJ, Buehner JJ, VanHiel LR, Sisto SA, Basso DM. Are the 10 meter and 6 minute walk tests redundant in patients with spinal cord injury? PLoS One 2014; 9:e94108. [PMID: 24788068 PMCID: PMC4006773 DOI: 10.1371/journal.pone.0094108] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 03/12/2014] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate the relationship and redundancy between gait speeds measured by the 10 Meter Walk Test (10MWT) and 6 Minute Walk Test (6MWT) after motor incomplete spinal cord injury (iSCI). To identify gait speed thresholds supporting functional ambulation as measured with the Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI). Design Prospective observational cohort. Setting Seven outpatient rehabilitation centers from the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN). Participants 249 NRN patients with American Spinal Injury Association Impairment Scale (AIS) level C (n = 20), D (n = 179) and (n = 50) iSCI not AIS evaluated, from February 2008 through April 2011. Interventions Locomotor training using body weight support and walking on a treadmill, overground and home/community practice. Main Outcome Measure(s) 10MWT and 6MWT collected at enrollment, approximately every 20 sessions, and upon discharge. Results The 10MWT and 6MWT speeds were highly correlated and the 10MWT speeds were generally faster. However, the predicted 6MWT gait speed from the 10MWT, revealed increasing error with increased gait speed. Regression lines remained significantly different from lines of agreement, when the group was divided into fast (≥0.44 m/s) and slow walkers (<0.44 m/s). Significant differences between 6MWT and 10MWT gait speeds were observed across SCI-FAI walking mobility categories (Wilcoxon sign rank test p<.001), and mean speed thresholds for limited community ambulation differed for each measure. The smallest real difference for the 6MWT and 10MWT, as well as the minimally clinically important difference (MCID) values, were also distinct for the two tests. Conclusions While the speeds were correlated between the 6MWT and 10MWT, redundancy in the tests using predictive modeling was not observed. Different speed thresholds and separate MCIDs were defined for community ambulation for each test.
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Affiliation(s)
- Gail F. Forrest
- Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange, New Jersey, United States of America
- Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, United States of America
- * E-mail:
| | - Karen Hutchinson
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, United States of America
| | - Douglas J. Lorenz
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, United States of America
- Kentucky Spinal Cord Research Center, University of Louisville, Louisville, Kentucky, United States of America
| | - Jeffrey J. Buehner
- Wexner Medical Center at the Ohio State University- Dodd Hall, Columbus, Ohio, United States of America
| | - Leslie R. VanHiel
- Hulse Spinal Cord Injury Lab and Crawford Research Institute, Shepherd Center, Atlanta, Georgia, United States of America
| | - Sue Ann Sisto
- State University of New York at Stony Brook, School of Health Technology and Management, Research and Development Park, Rehabilitation Research and Movement Performance Laboratory, Stony Brook, New York, United States of America
| | - D. Michele Basso
- The Ohio State University, School of Allied Medical Professions, Center for Brain and Spinal Cord Repair, Columbus, Ohio, United States of America
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479
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Bazley FA, Maybhate A, Tan CS, Thakor NV, Kerr C, All AH. Enhancement of bilateral cortical somatosensory evoked potentials to intact forelimb stimulation following thoracic contusion spinal cord injury in rats. IEEE Trans Neural Syst Rehabil Eng 2014; 22:953-64. [PMID: 24801738 DOI: 10.1109/tnsre.2014.2319313] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The adult central nervous system is capable of significant reorganization and adaptation following neurotrauma. After a thoracic contusive spinal cord injury (SCI) neuropathways that innervate the cord below the epicenter of injury are damaged, with minimal prospects for functional recovery. In contrast, pathways above the site of injury remain intact and may undergo adaptive changes in response to injury. We used cortical somatosensory evoked potentials (SSEPs) to evaluate changes in intact forelimb pathways. Rats received a midline contusion SCI, unilateral contusion SCI, or laminectomy with no contusion at the T8 level and were monitored for 28 days post-injury. In the midline injury group, SSEPs recorded from the contralateral forelimb region of the primary somatosensory cortex were 59.7% (CI 34.7%, 84.8%; c(2) = 21.9; dof = 1; p = 2.9 ×10(-6)) greater than the laminectomy group; SSEPs from the ipsilateral somatosensory cortex were 47.6% (CI 18.3%, 77%; c(2) = 10.1; dof = 1; p = 0.001) greater. Activation of the ipsilateral somatosensory cortex was further supported by BOLD-fMRI, which showed increased oxygenation at the ipsilateral hemisphere at day seven post-injury. In the unilateral injury group, ipsilesional side was compared to the contralesional side. SSEPs on day 14 (148%; CI 111%, 185%) and day 21 (137%; CI 110%, 163%) for ipsilesional forelimb stimulation were significantly increased over baseline (100%). SSEPs recorded from the hindlimb sensory cortex upon ipsilesional stimulation were 33.9% (CI 14.3%, 53.4%; c(2) = 11.6; dof = 1; p = 0.0007) greater than contralesional stimulation. Therefore, these results demonstrate the ability of SSEPs to detect significant enhancements in the activation of forelimb sensory pathways following both midline and unilateral contusive SCI at T8. Reorganization of forelimb pathways may occur after thoracic SCI, which SSEPs can monitor to aid the development of future therapies.
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480
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Increased Risk of Deep Vein Thrombosis and Pulmonary Thromboembolism in Patients with Spinal Cord Injury: A Nationwide Cohort Prospective Study. Thromb Res 2014; 133:579-84. [DOI: 10.1016/j.thromres.2014.01.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/19/2013] [Accepted: 01/07/2014] [Indexed: 11/17/2022]
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481
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Osterthun R, Post MWM, van Asbeck FWA, van Leeuwen CMC, van Koppenhagen CF. Causes of death following spinal cord injury during inpatient rehabilitation and the first five years after discharge. A Dutch cohort study. Spinal Cord 2014; 52:483-8. [PMID: 24686827 DOI: 10.1038/sc.2014.28] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 02/18/2014] [Accepted: 02/18/2014] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective multicentre cohort study. OBJECTIVES To determine mortality, causes and determinants of death of individuals with spinal cord injury (SCI) within five years after first inpatient rehabilitation. SETTING The Netherlands. METHODS Patients were included on admission to first clinical rehabilitation after traumatic or nontraumatic SCI. INCLUSION CRITERIA age between 18 and 65, American Spinal Injury Association impairment scale A-D and expected long-term wheelchair dependency. Information about survival, cause of death, relevant comorbidity and psychosocial circumstances was obtained from the rehabilitation physician or general practitioner. Determinants of death were retrieved from a prospectively collected database. Deceased persons and survivors were compared using χ(2)-test and t-test. Cox regression analysis was performed to describe independent predictors of death. The Kaplan-Meier method was used to calculate survival curves for independent predictors. Excess mortality was described by a standardized mortality ratio (SMR). RESULTS Mean duration of follow up was 6.2 years. A total of 27 persons (12.2%) died during this period (SMR 5.3). Main causes of death were cardiovascular disease (37.0%), pulmonary disease (29.6%) and neoplasm (14.8%). Older age at injury, nontraumatic SCI, family history of cardiovascular disease, less social support and a history of other medical conditions on admission were related to death. Older age at injury, nontraumatic SCI and a history of other medical conditions were independent predictors of death. CONCLUSION Twelve per cent of persons with SCI who had survived the acute hospital phase died during follow up (SMR 5.3). The main causes of death were cardiovascular and pulmonary disease.
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Affiliation(s)
- R Osterthun
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - M W M Post
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - F W A van Asbeck
- Department of Spinal Cord Management, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - C M C van Leeuwen
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - C F van Koppenhagen
- Department of Spinal Cord Management, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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482
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Clark F, Pyatak EA, Carlson M, Blanche EI, Vigen C, Hay J, Mallinson T, Blanchard J, Unger JB, Garber SL, Diaz J, Florindez LI, Atkins M, Rubayi S, Azen SP. Implementing trials of complex interventions in community settings: the USC-Rancho Los Amigos pressure ulcer prevention study (PUPS). Clin Trials 2014; 11:218-29. [PMID: 24577972 PMCID: PMC3972348 DOI: 10.1177/1740774514521904] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Randomized trials of complex, non-pharmacologic interventions implemented in home and community settings, such as the University of Southern California (USC)-Rancho Los Amigos National Rehabilitation Center (RLANRC) Pressure Ulcer Prevention Study (PUPS), present unique challenges with respect to (1) participant recruitment and retention, (2) intervention delivery and fidelity, (3) randomization and assessment, and (4) potential inadvertent treatment effects. PURPOSE We describe the methods employed to address the challenges confronted in implementing PUPS. In this randomized controlled trial, we are assessing the efficacy of a complex, preventive intervention in reducing the incidence of, and costs associated with, the development of medically serious pressure ulcers in people with spinal cord injury. METHODS Individuals with spinal cord injury recruited from RLANRC were assigned to either a 12-month preventive intervention group or a standard care control group. The primary outcome is the incidence of serious pressure ulcers with secondary endpoints including ulcer-related surgeries, medical treatment costs, and quality of life. These outcomes are assessed at 12 and 24 months after randomization. Additionally, we are studying the mediating mechanisms that account for intervention outcomes. RESULTS PUPS has been successfully implemented, including recruitment of the target sample size of 170 participants, assurance of the integrity of intervention protocol delivery with an average 90% treatment adherence rate, and enactment of the assessment plan. However, implementation has been replete with challenges. To meet recruitment goals, we instituted a five-pronged approach customized for an underserved, ethnically diverse population. In intervention delivery, we increased staff time to overcome economic and cultural barriers to retention and adherence. To ensure treatment fidelity and replicability, we monitored intervention protocol delivery in accordance with a rigorous plan. Finally, we have overcome unanticipated assessment and design concerns related to (1) determining pressure ulcer incidence/severity, (2) randomization imbalance, and (3) inadvertent potential control group contamination. LIMITATIONS We have addressed the most daunting challenges encountered in the recruitment, assessment, and intervention phases of PUPS. Some challenges and solutions may not apply to trials conducted in other settings. CONCLUSIONS Overcoming challenges has required a multifaceted approach incorporating individualization, flexibility, and persistence, as well as the ability to implement needed mid-course corrections.
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Affiliation(s)
- Florence Clark
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth A. Pyatak
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Mike Carlson
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Erna Imperatore Blanche
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Cheryl Vigen
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Joel Hay
- Leonard Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Trudy Mallinson
- School of Medicine and Health Sciences, The University of George Washington, Washington, DC, USA
| | - Jeanine Blanchard
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B. Unger
- Institute for Health Promotion and Disease Prevention Research, University of Southern California, Los Angeles, CA, USA
| | - Susan L. Garber
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Jesus Diaz
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lucia I. Florindez
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Michal Atkins
- Pressure Ulcer Management Service, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Salah Rubayi
- Pressure Ulcer Management Service, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Stanley Paul Azen
- Division of Biostatistics, University of Southern California, Los Angeles, CA, USA
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483
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Medication before and after a spinal cord lesion. Spinal Cord 2014; 52:358-63. [PMID: 24614857 DOI: 10.1038/sc.2014.20] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 01/05/2014] [Accepted: 01/28/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To map the impact of spinal cord lesion (SCL) on medication. STUDY DESIGN Registration of medication for 72 patients before SCL and at discharge from the Department for Spinal Cord Injuries. SETTING Department for Spinal Cord Injuries, East Denmark. METHODS The changes in medication for each Anatomical Therapeutic Chemical (ATC) Classification System group were registered for all patients, who were discharged from Department for Spinal Cord Injuries during 2010. The changes in medication per se were calculated for different parts of the population: non-traumatic, traumatic patients, men, women, paraplegia, tetraplegia, American Spinal Injury Association Impairment Scale (AIS) A, B or C, AIS D, age 0-45, 46-60 and 60+. In addition, comparisons of changes in medication were made between complementary parts of the population. RESULTS The overall increase in medication after SCL was 3.29 times (P<0.001). Statistically significant increases were seen for most medicine categories. When studying subgroups of the population, the increase was most constantly seen for the medicine in the groups 'Alimentary tract and metabolism' and 'Nervous system'. The highest overall increases were seen in patients with AIS A, B and C compared with AIS D (P<0.05). There was no difference between traumatic and non-traumatic SCL, men and women, and younger compared with older patients. CONCLUSION SCL elicits a general massive need for medicine. The relative increase is most pronounced for the more severely injured (AIS A, B and C). The increase in medication may have implications for side effects and for the economy of all involved.
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484
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Hasegawa T, Uchiyama Y, Uemura K, Harada Y, Sugiyama M, Tanaka H. Physical impairment and walking function required for community ambulation in patients with cervical incomplete spinal cord injury. Spinal Cord 2014; 52:396-9. [DOI: 10.1038/sc.2014.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 01/28/2014] [Accepted: 02/03/2014] [Indexed: 11/09/2022]
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485
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Bravo-Esteban E, Taylor J, Aleixandre M, Simon-Martínez C, Torricelli D, Pons JL, Gómez-Soriano J. Tibialis Anterior muscle coherence during controlled voluntary activation in patients with spinal cord injury: diagnostic potential for muscle strength, gait and spasticity. J Neuroeng Rehabil 2014; 11:23. [PMID: 24594207 PMCID: PMC3973993 DOI: 10.1186/1743-0003-11-23] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 02/12/2014] [Indexed: 12/11/2022] Open
Abstract
Background Coherence estimation has been used as an indirect measure of voluntary neurocontrol of residual motor activity following spinal cord injury (SCI). Here intramuscular Tibialis Anterior (TA) coherence estimation was performed within specific frequency bands for the 10-60 Hz bandwidth during controlled ankle dorsiflexion in subjects with incomplete SCI with and without spasticity. Methods In the first cohort study 15 non-injured and 14 motor incomplete SCI subjects were recruited to evaluate TA coherence during controlled movement. Specifically 15-30 Hz EMG was recorded during dorsiflexion with: i) isometric activation at 50, 75 and 100% of maximal voluntary torque (MVT), ii) isokinetic activation at 60 and 120°/s and iii) isotonic dorsiflexion at 50% MVT. Following identification of the motor tasks necessary for measurement of optimal TA coherence a second cohort was analyzed within the 10-16 Hz, 15-30 Hz, 24-40 Hz and 40-60 Hz bandwidths from 22 incomplete SCI subjects, with and without spasticity. Results Intramuscular 40-60 Hz, but not 15-30 Hz TA, coherence calculated in SCI subjects during isometric activation at 100% of MVT was lower than the control group. In contrast only isometric activation at 100% of MVT 15-30 Hz TA coherence was higher in subjects with less severe SCI (AIS D vs. AIS C), and correlated functionally with dorsiflexion MVT. Higher TA coherence was observed for the SCI group during 120°/s isokinetic movement. In addition 15-30 Hz TA coherence calculated during isometric activation at 100% MVT or 120°/s isokinetic movement correlated moderately with walking function and time from SCI, respectively. Spasticity symptoms correlated negatively with coherence during isometric activation at 100% of MVT in all tested frequency bands, except for 15-30 Hz. Specifically, 10-16 Hz coherence correlated inversely with passive resistive torque to ankle dorsiflexion, while clinical measures of muscle hypertonia and spasm severity correlated inversely with 40-60 Hz. Conclusion Analysis of intramuscular 15-30 Hz TA coherence during isometric activation at 100% of MVT is related to muscle strength and gait function following incomplete SCI. In contrast several spasticity symptoms correlated negatively with 10-16 Hz and 40-60 Hz TA coherence during isometric activation at 100% MVT. Validation of the diagnostic potential of TA coherence estimation as a reliable and comprehensive measure of muscle strength, gait and spasticity should facilitate SCI neurorehabilation.
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Affiliation(s)
| | | | | | | | | | | | - Julio Gómez-Soriano
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, Toledo, Spain.
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486
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Torrecilha LA, Costa BT, Lima FB, Santos SMS, Souza RBD. O perfil da sexualidade em homens com lesão medular. FISIOTERAPIA EM MOVIMENTO 2014. [DOI: 10.1590/0103-5150.027.001.ao04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Introdução Entre as consequências da lesão medular (LM), está o deficit na função sexual, o que interfere na qualidade de vida do indivíduo. Objetivos Conhecer e descrever o perfil da sexualidade de homens com LM, comparando os períodos pré e pós-lesão. Materiais e métodos Estudo transversal com 36 homens com LM. Os dados foram coletados através de um questionário (QSH-LM) e um roteiro. As variáveis quantitativas foram apresentadas por média e desvio padrão. As variáveis categóricas foram apresentadas por frequências absolutas e relativas e as associações foram realizadas através do teste Qui-quadrado. Todos os testes apresentaram significância de 5%. Resultados Houve prevalência de pacientes paraplégicos e de lesões do tipo completa. A prática, frequência, desejo e satisfação sexual decaíram após a LM, assim como as respostas sexuais. Dentre essas estão ereção, ejaculação e orgasmo, que decaíram de forma relevante após a LM. A sensação mais relatada durante o ato sexual foi o aumento da resposta cardiorrespiratória, antes ou após a LM, e mais indivíduos passaram a sentir nenhuma sensação durante a atividade sexual após a LM. Houve significativa associação entre tipo de lesão e presença de orgasmo e entre prática e satisfação sexual após a LM. Conclusão Foi observado que a resposta sexual após a LM altera na ordem crescente: ereção, orgasmo e ejaculação. Percebe-se que muitas vezes a reabilitação é focada nas capacidades motoras e a sexualidade é pouco abordada.
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487
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Aito S, Tucci L, Zidarich V, Werhagen L. Traumatic spinal cord injuries: evidence from 30 years in a single centre. Spinal Cord 2014; 52:268-71. [PMID: 24492638 DOI: 10.1038/sc.2014.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 11/25/2013] [Accepted: 12/17/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective data analysis. OBJECTIVES Traumatic spinal cord injury (TSCI) is a devastating injury that causes a lifelong disability, involving mostly young men. The aim of the study was to analyse some clinical and epidemiological features of TSCI patients admitted to the Spinal Unit of Florence, Italy, during 30 years, from 1981 to 2010. SETTING Spinal Unit, Careggi University Hospital, Florence, Italy. METHODS The medical files from the computerised database of the patients who sustained TSCI from 1 January 1981 to 31 December 2010 and received comprehensive care in the same centre were analysed. Information was collected with regard to demographic data, causes of injury, time of injury, associated injuries, treatment of the vertebral lesion and neurological condition at discharge. RESULTS A total of 1479 patients were included. The number of two-wheeler road traffic accidents (RTAs) has increased over the years, whereas the percentage of falls and sports accidents has been quite constant. The lesions due to 4-wheeler RTAs tend to decrease. Lesions due to falls mainly affected older persons than those due to sports accidents, with a mean age at the time of injury of 52 and 25 years, respectively. Diving was the most common cause among sports and leisure accidents. Associated injuries were present in 56% of all the cases included. CONCLUSION The cases of spinal cord injury due to two-wheeler RTAs have increased over the years probably because of the increasing diffusion of the use of such a vehicle, and such an eventuality has to be taken into consideration in future prevention strategies.
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Affiliation(s)
- S Aito
- Spinal Unit, Careggi University Hospital, Florence, Italy
| | - L Tucci
- Spinal Unit, Careggi University Hospital, Florence, Italy
| | - V Zidarich
- Spinal Unit, Careggi University Hospital, Florence, Italy
| | - L Werhagen
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
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488
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Jarocha D, Milczarek O, Kawecki Z, Wendrychowicz A, Kwiatkowski S, Majka M. Preliminary study of autologous bone marrow nucleated cells transplantation in children with spinal cord injury. Stem Cells Transl Med 2014; 3:395-404. [PMID: 24493853 DOI: 10.5966/sctm.2013-0141] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The objective of this study was to assess the safety and efficacy of transplanting bone marrow nucleated cells (BMNCs) to treat children with complete interruption of spinal cord (SC) continuity. The present study was conducted from 2005 to 2011. The inclusion criteria were a magnetic resonance imaging-confirmed complete interruption of SC continuity and no improvement in neurological status within 6 months after standard therapy. Bone marrow was isolated from the iliac ala and submitted to BMNC isolation. Subsequently, the cell suspension was administered into the SC cavity and intravenously. In total, 18 of 19 intraspinal and intravenous BMNC transplantation procedures performed caused no adverse events. One case was connected with transient bradycardia. The experimental therapy showed no late complications in the 1- to 6-year follow-up evaluation period. Neurological improvement was observed in two patients who received multiple implantations. One patient demonstrated improved superficial sensation from Th3 to Th12/L1 and a restored bladder-filling sensation. In the other case, superficial sensation was improved from C2 to C5, and the respiratory drive, the swallowing reflex, and tongue movements were restored. Spasticity and quality of life were improved in three of five patients. In addition, skin pressure ulcers healed and did not recur. Our preliminary results demonstrate the safety and feasibility of BMNC transplantation in children with complete SC injury. The results indicate that a certain degree of neurological and quality-of-life improvement can be attained by children with chronic complete SC injury who receive multiple BMNC implantations.
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Affiliation(s)
- Danuta Jarocha
- Departments of Transplantation and Children's Neurosurgery, Jagiellonian University School of Medicine, Cracow, Poland
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489
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Cao Y, Massaro JF, Krause JS, Chen Y, Devivo MJ. Suicide Mortality After Spinal Cord Injury in the United States: Injury Cohorts Analysis. Arch Phys Med Rehabil 2014; 95:230-5. [DOI: 10.1016/j.apmr.2013.10.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/29/2013] [Accepted: 10/06/2013] [Indexed: 11/26/2022]
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490
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Shetye SS, Troyer KL, Streijger F, Lee JH, Kwon BK, Cripton PA, Puttlitz CM. Nonlinear viscoelastic characterization of the porcine spinal cord. Acta Biomater 2014; 10:792-7. [PMID: 24211612 DOI: 10.1016/j.actbio.2013.10.038] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/28/2013] [Accepted: 10/31/2013] [Indexed: 10/26/2022]
Abstract
Although quasi-static and quasi-linear viscoelastic properties of the spinal cord have been reported previously, there are no published studies that have investigated the fully (strain-dependent) nonlinear viscoelastic properties of the spinal cord. In this study, stress relaxation experiments and dynamic cycling were performed on six fresh porcine lumbar cord specimens to examine their viscoelastic mechanical properties. The stress relaxation data were fitted to a modified superposition formulation and a novel finite ramp time correction technique was applied. The parameters obtained from this fitting methodology were used to predict the average dynamic cyclic viscoelastic behavior of the porcine cord. The data indicate that the porcine spinal cord exhibited fully nonlinear viscoelastic behavior. The average weighted root mean squared error for a Heaviside ramp fit was 2.8 kPa, which was significantly greater (p<0.001) than that of the nonlinear (comprehensive viscoelastic characterization method) fit (0.365 kPa). Further, the nonlinear mechanical parameters obtained were able to accurately predict the dynamic behavior, thus exemplifying the reliability of the obtained nonlinear parameters. These parameters will be important for future studies investigating various damage mechanisms of the spinal cord and studies developing high-resolution finite elements models of the spine.
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491
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Yang R, Guo L, Wang P, Huang L, Tang Y, Wang W, Chen K, Ye J, Lu C, Wu Y, Shen H. Epidemiology of spinal cord injuries and risk factors for complete injuries in Guangdong, China: a retrospective study. PLoS One 2014; 9:e84733. [PMID: 24489652 PMCID: PMC3904832 DOI: 10.1371/journal.pone.0084733] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/19/2013] [Indexed: 11/23/2022] Open
Abstract
Background Spinal cord injuries are highly disabling and deadly injuries. Currently, few studies focus on non-traumatic spinal cord injuries, and there is little information regarding the risk factors for complete injuries. This study aims to describe the demographics and the injury characteristics for both traumatic and non-traumatic spinal cord injuries and to explore the risk factors for complete spinal cord injuries. Methods A retrospective study was performed by reviewing the medical records of 3,832 patients with spinal cord injuries who were first admitted to the sampled hospitals in Guangdong, China. The demographics and injury characteristics of the patients were described and compared between the different groups using the chi-square test. Logistic regression was conducted to analyze the risk factors for complete spinal cord injuries. Results The proportion of patients increased from 7.0% to 14.0% from 2003 to 2011. The male-to-female ratio was 3.0∶1. The major cause of spinal cord injuries was traffic accidents (21.7%). Many of the injured were workers (36.2%), peasants (22.8%), and unemployed people (13.9%); these occupations accounted for 72.9% of the total sample. A multivariate logistic regression model revealed that the OR (95% CI) for male gender compared to female gender was 1.25 (1.07–1.89), the OR (95%CI) for having a spinal fracture was 1.56 (1.35–2.60), the OR (95%CI) for having a thoracic injury was 1.23 (1.10–2.00), and the OR (95%CI) for having complications was 2.47 (1.96–3.13). Conclusion The proportion of males was higher than the proportion of females. Workers, peasants and the unemployed comprised the high-risk occupational categories. Male gender, having a spinal fracture, having a thoracic injury, and having complications were the major risk factors for a complete injury. We recommend that preventive measures should focus on high-risk populations, such as young males.
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Affiliation(s)
- Rui Yang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Peng Wang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Lin Huang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yong Tang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wenhao Wang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Keng Chen
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jichao Ye
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yanfeng Wu
- Biotherapy Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
- * E-mail: (YFW); shenh.y.@163.com (HYS)
| | - Huiyong Shen
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
- * E-mail: (YFW); shenh.y.@163.com (HYS)
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Elkabes S, Nicot AB. Sex steroids and neuroprotection in spinal cord injury: a review of preclinical investigations. Exp Neurol 2014; 259:28-37. [PMID: 24440641 DOI: 10.1016/j.expneurol.2014.01.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/25/2013] [Accepted: 01/04/2014] [Indexed: 11/30/2022]
Abstract
Spinal cord injury (SCI) is a debilitating condition that affects motor, sensory and autonomic functions. Subsequent to the first mechanical trauma, secondary events, which include inflammation and glial activation, exacerbate tissue damage and worsen functional deficits. Although these secondary injury mechanisms are amenable to therapeutic interventions, the efficacy of current approaches is inadequate. Further investigations are necessary to implement new therapies that can protect neural cells and attenuate some of the detrimental effects of inflammation while promoting regeneration. Studies on different animal models of SCI indicated that sex steroids, especially 17β-estradiol and progesterone, exert neuroprotective, anti-apoptotic and anti-inflammatory effects, ameliorate tissue sparing and improve functional deficits in SCI. As sex steroid receptors are expressed in a variety of cells including neurons, glia and immune system-related cells which infiltrate the injury epicenter, sex steroids could impact multiple processes simultaneously and in doing so, influence the outcomes of SCI. However, the translation of these pre-clinical findings into the clinical setting presents challenges such as the narrow therapeutic time window of sex steroid administration, the diversity of treatment regimens that have been employed in animal studies and the lack of sufficient information regarding the persistence of the effects in chronic SCI. The current review will summarize some of the major findings in this field and will discuss the challenges associated with the implementation of sex steroids as a promising treatment in human SCI.
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Affiliation(s)
- Stella Elkabes
- The Reynolds Family Spine Laboratory, Department of Neurological Surgery, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103, USA.
| | - Arnaud B Nicot
- UMR 1064, INSERM, Nantes, France; Faculté de Médecine, Université de Nantes, France; ITUN, CHU de Nantes, France
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493
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Tamplin J, Berlowitz DJ. A systematic review and meta-analysis of the effects of respiratory muscle training on pulmonary function in tetraplegia. Spinal Cord 2014; 52:175-80. [DOI: 10.1038/sc.2013.162] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/02/2013] [Accepted: 12/09/2013] [Indexed: 01/25/2023]
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494
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Selvarajah S, Hammond ER, Haider AH, Abularrage CJ, Becker D, Dhiman N, Hyder O, Gupta D, Black JH, Schneider EB. The burden of acute traumatic spinal cord injury among adults in the united states: an update. J Neurotrauma 2014; 31:228-38. [PMID: 24138672 DOI: 10.1089/neu.2013.3098] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The current incidence estimate of 40 traumatic spinal cord injuries (TSCI) per million population/year in the United States (U.S.) is based on data from the 1990s. We sought to update the incidence and epidemiology of TSCI in U.S adults by using the Nationwide Emergency Department Sample (NEDS), the largest all-payer emergency department (ED) database in the United States. Adult ED visits between 2007 and 2009 with a principal diagnosis of TSCI were identified using International Classification of Diseases (ICD)-9 codes (806.0-806.9 and 952.0-952.9). We describe TSCI cumulative incidence, mortality, discharge disposition, and hospital charges weighted to the U.S. population. The estimated 3-year cumulative incidence of TSCI was 56.4 per million adults. Cumulative incidence of TSCI in older adults increased from 79.4 per million older adults in 2007 to 87.7 by the end of 2009, but remained steady among younger adults. Overall, falls were the leading cause of TSCI (41.5%). ED charges rose by 20% over the study period, and death occurred in 5.7% of patients. Compared with younger adults, older adults demonstrated higher adjusted odds of mortality in the ED (adjusted odds ratio [AOR]=4.4; 95% confidence interval [CI]: 1.1-16.6), mortality during hospitalization (AOR=5.9; 95% CI: 4.7-7.4), and being discharged to chronic care (AOR=3.7; 95% CI: 3.0-4.5). The incidence of TSCI is higher than previously reported with a progressive increase among older adults who also experience worse outcomes compared with younger adults. ED-related TSCI charges are also increasing. These updated national estimates support the development of customized prevention strategies based on age-specific risk factors.
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Affiliation(s)
- Shalini Selvarajah
- 1 Center for Surgical Trials and Outcomes Research (CSTOR), Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland
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495
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Wang HT, Williamson DW, Albert MA. Predictors of ventilatory outcome in cervical spinal injuries. Crit Care 2014. [PMCID: PMC4069522 DOI: 10.1186/cc13640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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496
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Martin A, Abogunrin S, Kurth H, Dinet J. Epidemiological, humanistic, and economic burden of illness of lower limb spasticity in adults: a systematic review. Neuropsychiatr Dis Treat 2014; 10:111-22. [PMID: 24482572 PMCID: PMC3905098 DOI: 10.2147/ndt.s53913] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the epidemiological, humanistic, and economic burden of illness associated with adult lower limb spasticity (LLS) and its complications. METHODS A systematic search of MEDLINE and EMBASE identified 23 studies published between January 2002 and October 2012 that assessed the epidemiology, impact, and resource use associated with LLS. A hand-search of four neurology conferences identified abstracts published between 2010 and 2012. RESULTS LLS was found to occur in one third of adults after stroke, half to two thirds with multiple sclerosis, and three quarters with cerebral palsy. LLS limits mobility and reduces quality of life. No clear association was found between LLS and occurrence of pain, development of contractures, or risk of falls. CONCLUSION The evidence on the burden of LLS and its complications is surprisingly limited given the condition's high prevalence among adults with common disorders, such as stroke. Further research is needed to clarify the impact of LLS, including the likelihood of thrombosis in spastic lower limbs. The dearth of high-quality evidence for LLS suggests a lack of awareness of, and interest in, the problem, and therefore, the unmet need among patients and their carers.
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Li WC, Jiang R, Jiang DM, Zhu FC, Su B, Qiao B, Qi XT. Lipopolysaccharide preconditioning attenuates apoptotic processes and improves neuropathologic changes after spinal cord injury in rats. Int J Neurosci 2013; 124:585-92. [PMID: 24205811 DOI: 10.3109/00207454.2013.864289] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We have shown earlier that administration of low-dose lipopolysaccharide (LPS) significantly contributed to recovery of motor function after traumatic spinal cord injury in the adult female rat. Using the same standardized animal model, we have now designed a set of experiments to test the hypothesis that LPS preconditioning attenuates stress-related apoptotic processes early after spinal cord trauma. The lower thoracic spinal cord injury in adult female Sprague-Dawley rats was caused by a 10 g weight rod drop from 25 mm on the dural surface of the exposed spinal cord at T10. The rats were randomly assigned to three groups: Sham injury, control (received normal saline alone), and LPS preconditioning (0.2 mg/kg, ip; 72 h prior to the injury). The animals were euthanized at 72 h postinjury. Neuropathologic changes were assessed using hematoxylin and eosin staining. SCI-induced apoptosis were observed by transmission electron microscopy. Caspase-3, cleaved caspase-3, Bax, and Bcl-2 were examined with immunohistochemistry or Western blotting. Compared with the control group, LPS preconditioning group showed significant improvement in the SCI-induced morphology changes. Furthermore, LPS preconditioning reduced the expressions of apoptotic markers caspase-3, cleaved caspase-3, and Bax, upregulated the expression of antiapoptotic marker Bcl-2 in the samples of spinal cord. Low-dose LPS attenuated the recruitment of inflammatory cells and the proliferation of glial cells in the site of injury. LPS preconditioning has neuroprotective effects against TSCI in rats due to its antiapoptosis properties as shown by the inhibition of caspase pathway and the upregulation of antiapoptotic protein.
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Affiliation(s)
- Wei-Chao Li
- 1Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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498
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Sleep disorders in patients with spinal cord injury. Sleep Med Rev 2013; 17:399-409. [DOI: 10.1016/j.smrv.2012.12.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 12/25/2012] [Accepted: 12/26/2012] [Indexed: 11/22/2022]
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499
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Koenraadt KLM, Duysens J, Rijken H, van Nes IJW, Keijsers NLW. Preserved foot motor cortex in patients with complete spinal cord injury: a functional near-infrared spectroscopic study. Neurorehabil Neural Repair 2013; 28:179-87. [PMID: 24213959 DOI: 10.1177/1545968313508469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Since the brain is intact, persons with a spinal cord injury (SCI) might benefit from a brain-computer interface (BCI) to improve mobility by making use of functional near-infrared spectroscopy (fNIRS). OBJECTIVE We aimed to use fNIRS to detect contralateral primary motor cortex activity during attempted foot movements in participants with complete SCI. METHODS A 6-channel fNIRS, including 2 reference channels, measured relative concentration changes of oxy- (HbO) and deoxy-hemoglobin (HbR) in the contralateral motor cortex for the right foot. Seven subjects, studied within 18 months after injury, performed 12 trials of attempted right foot and real hand movements. RESULTS T tests revealed significant HbO and HbR responses of the left motor cortex for attempted foot movements, but not for right hand movements. A 2-way repeated-measures analysis of variance revealed a larger decrease in HbR for attempted foot movements compared to hand movements. Individual results show major interindividual differences in (number of) channels activated and the sensitive chromophore (HbR or HbO). CONCLUSIONS On group level, activity in the motor cortex of the foot can be measured with fNIRS in patients with complete SCI during attempted foot movements and might in principle be used in future BCI studies and applications.
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500
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Hawkins C, Coffee P, Soundy A. Considering how athletic identity assists adjustment to spinal cord injury: a qualitative study. Physiotherapy 2013; 100:268-74. [PMID: 24373892 DOI: 10.1016/j.physio.2013.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To establish how sport, and access to an athletic identity, has been used when adjusting to a spinal cord injury. DESIGN Qualitative study using semi-structured interviews. SETTING Private athletic club. PARTICIPANTS Eight (six males and two females) athletes from a wheelchair badminton club participated in the study. The individuals had finished rehabilitation, and were aged between 20 and 50 years. MAIN OUTCOME MEASURES A single semi-structured interview was undertaken with each participant. RESULTS Following the thematic analysis, two final themes were presented: (1) adjustment and paradox of chronic illness; and (2) the role and value of an athletic identity. CONCLUSIONS Badminton provided participants with an opportunity to continue and develop a positive athletic identity. Identity may be used as a factor that can promote recovery, and is considered as a way to encourage and maintain positive long-term adjustment to disability.
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Affiliation(s)
- C Hawkins
- Department of Physiotherapy, University of Birmingham, Edgbaston, Birmingham, UK
| | - P Coffee
- School of Sport, University of Stirling, Stirling, UK
| | - A Soundy
- Department of Physiotherapy, University of Birmingham, Edgbaston, Birmingham, UK.
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