Neurologic Recovery and Neurologic Decline After Spinal Cord Injury

Sex Hormone Levels and Functional Outcomes

OBJECTIVES

To investigate testosterone and free testosterone levels in male patients after spinal cord injury (SCI) in comparison with healthy subjects, the effects of free testosterone on Functional Independence Measure (FIM) instrument, and their relationship between time since injury, spinal cord injury levels, and testosterone levels.

DESIGN

Prospective case series during 2004-2005. Male patients with SCI (n = 44) and a control group (n = 42) from healthy volunteers with similar age and body mass index were included in the study. Plasma luteinizing hormone (LH) was measured along with testosterone and free testosterone in the same blood sample. The FIM instrument was administered at the admission to hospital and at discharge.

RESULTS

Serum LH levels were significantly higher in both patient subgroups than in the control group (P < 0.01 and 0.03). Free testosterone levels were lower in the subgroup with time since injury <or=12 mos than in the other patient subgroup and the control group (P = 0.01 and 0.02). No significance was found between androgen status and FIM change.

CONCLUSIONS

Our findings suggest that a negative androgen status might be notable especially in the first year after spinal cord injury. However, the androgen status does not correlate with functional outcome in patients coming for rehabilitation after spinal cord injury.

Long-term follow-up of patients with spinal cord injury

OBJECTIVE

The aim of this study was to evaluate the motor, sensory, and functional recovery in patients with spinal cord injury (SCI).

METHODS

Forty-one patients with SCI participated in this study. Twenty patients were evaluated after discharge. Each patient was evaluated by the American Spinal Injury Association (ASIA) impairment scale and the Functional Independence Measure (FIM) at admission, before discharge, and at least at 6 months after discharge. Friedman, Dunn, and Mann-Whitney U tests were used for statistical analysis.

RESULTS

There were 17 male and 3 female patients. Seven patients had complete SCI, and 13 patients had incomplete SCI. The evaluation of motor, sensory, and FIM scores at admission showed significant improvement in all of the patients during the follow-up period (P < 0.0001). Five incompletely injured cases improved with regard to ASIA staging. Motor and FIM scores significantly increased at follow-up for converted and unconverted patients. All parameters increased at follow-up in patients who were complete and incomplete. Motor scores significantly increased at discharge and at follow-up. FIM scores also increased significantly at follow-up in incomplete patients.

CONCLUSION

Motor, sensory, and FIM scores increased in patients with SCI after a follow-up period of 18 months. Improvement to a higher ASIA stage could be accomplished by 25% of the patients. Although both complete and incomplete patients recovered significantly at the follow-up period, only incompletely injured cases could convert to a higher ASIA stage.

Effect of injury severity on lower urinary tract function after experimental spinal cord injury

Lower urinary tract dysfunction is a serious burden for patients following spinal cord injury. Patients are usually limited to treatment with urinary drainage catheters, which can lead to repeated urinary tract infections and lower quality of life. Most of the information previously obtained regarding lower urinary tract function after spinal cord injury has been in completely transected animals. After thoracic transection in the rat, plasticity of local lumbosacral spinal circuitry establishes a "reflex bladder," which results in partial recovery of micturition, albeit with reduced voiding efficiency. Since at least half of cord-injured patients exhibit neurologically incomplete injury, rat models of clinically relevant incomplete contusion injury have been developed. With respect to lower urinary tract function, recent anatomical and physiological studies have been performed after incomplete thoracic contusion injury. The results show greater recovery of lower urinary tract function that varies inversely with the severity of the initial trauma and is positively correlated with time after injury. Recovery, as measured by coordination of the bladder with the external urethral sphincter, occurs between 1 and 4 weeks after spinal cord injury. It is associated with normalization of: serotonin immunoreactivity and glutamate receptor subunit mRNA expression in the dorsolateral nucleus that innervates the external urethral sphincter muscle, the response to glutamatergic pharmacological probes administered at the lumbosacral spinal cord level, and c-Fos activation patterns in the lumbar spinal cord. Understanding the mechanisms involved in this recovery will provide a basis for enhancing lower urinary tract function in patients after incomplete spinal cord injury.

Spinal shock revisited: a four-phase model

Spinal shock has been of interest to clinicians for over two centuries. Advances in our understanding of both the neurophysiology of the spinal cord and neuroplasticity following spinal cord injury have provided us with additional insight into the phenomena of spinal shock. In this review, we provide a historical background followed by a description of a novel four-phase model for understanding and describing spinal shock. Clinical implications of the model are discussed as well.

Spinal cord injury medicine. 5. Preserving wellness and independence of the aging patient with spinal cord injury: a primary care approach for the rehabilitation medicine specialist

This self-directed learning module highlights consideration and treatment of individuals with long-term spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the challenges of chronic disease prevention, diagnosis, therapeutic options, and the resultant impact on the person with long-term SCI. With cardiovascular disease becoming a leading cause of mortality in this population, risk factor modification through weight, lipid, and glucose control becomes more important. Likewise, bowel dysfunction increases with duration and severity of SCI. Conservative and surgical management options are discussed. Musculoskeletal repetitive trauma injuries occur commonly in long-term SCI but can be prevented with appropriate lifestyle or equipment modifications. These and other conditions occurring in the person with long-term SCI are closely related to psychosocial function with resultant social isolation, depression, and substance abuse. Thus, identification and surveillance of these comorbidities are addressed, with an emphasis on prevention.

OVERALL ARTICLE OBJECTIVE

To summarize the unique medical, psychosocial, and functional needs of the individual with long-term SCI.