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Korupolu R. Intrathecal baclofen therapy for spasticity in a person with spinal cord injury and end-stage renal disease dependent on hemodialysis: a case report. Spinal Cord Ser Cases 2024; 10:51. [PMID: 39069535 DOI: 10.1038/s41394-024-00666-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 07/10/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION Spasticity is one of the most common secondary complications following a spinal cord injury (SCI), which can significantly debilitate a patient irrespective of the severity of the injury. Intrathecal baclofen therapy can effectively reduce global spasticity in bilateral lower extremities at lower doses and allows precise dose titration to manage spasticity optimally. In complex patients with spasticity and multiple medical comorbidities, multidisciplinary teamwork is required to assess ITB safety and deliver timely intervention to prevent secondary complications of spasticity and improve quality of life. CASE PRESENTATION A 61-year-old African American male with multiple comorbidities, including end-stage renal disease (ESRD) requiring dialysis sustained non-traumatic SCI due to epidural abscess resulting in paraplegia and severe debilitating spasticity. Spasticity gradually worsened and interfered with his ability to achieve independence with functional activities appropriate for his neurological level of injury. A multidisciplinary team approach in this complex case resulted in a successful ITB trial and subsequent ITB implantation, resulting in reduced spasticity and improved quality of life. To our knowledge, this is the first case report of the administration of intrathecal baclofen pump therapy in a person with SCI and end-stage renal disease (ESRD) dependent on hemodialysis. DISCUSSION ITB therapy can be safely delivered in a person with SCI and multiple medical comorbidities, including ESRD, dependent on hemodialysis to manage spasticity. However, a careful evaluation and discussion among the multidisciplinary team managing the patient's morbidities and patient is required to assess the risks and benefits of ITB therapy to allow the patient to make an informed decision.
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Affiliation(s)
- Radha Korupolu
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Sciences Center at Houston, Houston, TX, USA.
- TIRR Memorial Hermann, Houston, TX, USA.
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Hoekstra S, Ettema F, van der Bijll M, van der Sterren V, van Binsbergen E, van Orsouw L, Achterberg W, Daanen H, Janssen T, de Groot S. The effect of breathing exercises and mindset with or without cold exposure on mental and physical health in persons with a spinal cord injury-a protocol for a three-arm randomised-controlled trial. Spinal Cord 2024; 62:237-240. [PMID: 38491303 DOI: 10.1038/s41393-024-00976-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
STUDY DESIGN A three-arm randomized controlled trial. OBJECTIVES To investigate the effects of the Wim Hof Method (WHM), with (WHM-C) and without cold exposure (WHM-NC), on mental and physical health in persons with chronic spinal cord injury (SCI). SETTING Rehabilitation centre (assessments and once-weekly intervention sessions) and home-based (daily intervention sessions). METHODS Sixty adults with chronic SCI will be randomised (1:1:1) to one of three groups: participants in the intervention groups (i.e., WHM-C and WHM-NC) will engage in a 7-week intervention, with one weekly practice session at the rehabilitation centre and a daily WHM session at home. WHM-NC will consist of breathing exercises and mindset, while participants in WHM-C will partake in breathing exercises, mindset and cold exposure. Participants allocated to usual care (UC) will not receive the WHM intervention. The primary outcome is mental health reported via the Mental Health Inventory (MHI)-5, while secondary outcomes include circulating inflammatory and metabolic marker concentration, pulmonary function, body composition, sleep quality, spasticity, chronic pain and psychological stress. ETHICS AND DISSEMINATION Ethics approval has been obtained from the medical ethics committee of the Máxima Medical Centre (Veldhoven, the Netherlands; identifier: w22.069). If shown efficacious in improving mental health, as well as physical health, in persons with chronic SCI, the low cost and accessibility of the WHM allows it to be directly implemented in SCI rehabilitation. TRIAL REGISTRATION NUMBER NCT05704322.
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Affiliation(s)
- Sven Hoekstra
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Frank Ettema
- Reade Center for Rehabilitation & Rheumatology, Amsterdam, The Netherlands
| | - Max van der Bijll
- Reade Center for Rehabilitation & Rheumatology, Amsterdam, The Netherlands
| | | | | | - Ludwine van Orsouw
- Reade Center for Rehabilitation & Rheumatology, Amsterdam, The Netherlands
| | - Wendy Achterberg
- Reade Center for Rehabilitation & Rheumatology, Amsterdam, The Netherlands
| | - Hein Daanen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Thomas Janssen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Rehabilitation Research Center Reade, Amsterdam, The Netherlands
| | - Sonja de Groot
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
- Amsterdam Rehabilitation Research Center Reade, Amsterdam, The Netherlands.
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de Groot S, Ettema FWL, van Leeuwen CMC, Achterberg WJ, Janssen TWJ, Hoekstra SP. The Effect of Mindset and Breathing Exercises on Physical and Mental Health in Persons with Spinal Cord Injury-A Pilot Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6784. [PMID: 37754643 PMCID: PMC10531230 DOI: 10.3390/ijerph20186784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/12/2023] [Accepted: 09/16/2023] [Indexed: 09/28/2023]
Abstract
This study investigated the feasibility and efficacy of mindset and breathing exercises (Wim Hof Method (WHM)) on physical and mental health in persons with spinal cord injury (SCI). Ten individuals with SCI participated in this pilot study. These ten participants followed a 4-week WHM intervention, with one weekly group session in the rehabilitation center and daily practice at home using the WHM app. An in-person exit-interview was conducted post-intervention to collect qualitative information on participants' experiences, regarding the feasibility and effects of the intervention. Furthermore, tests and questionnaires were administered pre- and post-intervention to assess physical and mental health outcomes. Adherence to the weekly in-person meetings was excellent and no adverse events occurred. Physical and mental health outcomes in this small sample size showed some pre-post differences. This pilot feasibility study provides preliminary evidence supporting the feasibility and efficacy of the WHM, including mindset and breathing exercises, on physical and mental health of people with SCI. These results warrant a randomized-controlled trial, including cold exposure, of this novel intervention in people with SCI.
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Affiliation(s)
- Sonja de Groot
- Amsterdam Rehabilitation Research Center, Reade, 1054 HW Amsterdam, The Netherlands;
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 BT Amsterdam, The Netherlands
| | - Frank W. L. Ettema
- Reade Center for Rehabilitation & Rheumatology, 1054 HW Amsterdam, The Netherlands; (F.W.L.E.); (W.J.A.)
| | - Christel M. C. van Leeuwen
- Centre of Excellence for Rehabilitation Medicine, University Medical Centre Utrecht Brain Centre, University Medical Centre Utrecht, 3583 TM Utrecht, The Netherlands;
- Department of Spinal Cord Injury and Orthopedics, De Hoogstraat Rehabilitation, 3583 TM Utrecht, The Netherlands
| | - Wendy J. Achterberg
- Reade Center for Rehabilitation & Rheumatology, 1054 HW Amsterdam, The Netherlands; (F.W.L.E.); (W.J.A.)
| | - Thomas W. J. Janssen
- Amsterdam Rehabilitation Research Center, Reade, 1054 HW Amsterdam, The Netherlands;
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 BT Amsterdam, The Netherlands
| | - Sven P. Hoekstra
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA;
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
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Gao F, Li JJ, Liu JY, Li YJ, Cong XY, Talifu Z, Zhang X. Association between brain N-acetylaspartate levels and sensory and motor dysfunction in patients who have spinal cord injury with spasticity: an observational case-control study. Neural Regen Res 2023; 18:582-586. [DOI: 10.4103/1673-5374.350216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Korupolu R, Malik A, Pemberton E, Stampas A, Li S. Phenol neurolysis in people with spinal cord injury: a descriptive study. Spinal Cord Ser Cases 2022; 8:90. [PMID: 36481543 PMCID: PMC9732339 DOI: 10.1038/s41394-022-00556-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/12/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Descriptive study. OBJECTIVES The study's main objective was to describe the common targets of phenol neurolysis and review the safety and efficacy of the dose used for this spasticity management procedure in people with spinal cord injury (SCI). SETTING An acute rehabilitation hospital. METHODS Data from people with SCI who underwent phenol neurolysis procedures for spasticity management between April 2017 and August 2018 were included in this study. We collected demographics and phenol neurolysis procedure-related information. RESULTS A total of 66 people with SCI and spasticity underwent phenol neurolysis of 303 nerves over 102 encounters. During these encounters, 97% of procedures were performed using both electrical stimulation and ultrasound guidance. The median (IQR) total volume of 6% aqueous phenol used per encounter was 4.0 (2.0-6.0) ml with a median (IQR) of 1.5 (1.0-2.3) ml per nerve. The most frequent target was the obturator nerve (33%), followed by the pectoral nerves (23%). Immediate post-phenol neurolysis improvement or reduction in spasticity was reported for 92% of all documented encounters. There was no documentation of any post-procedure-related adverse events in this cohort during this specified time frame. CONCLUSIONS Our findings suggest that phenol neurolysis can be safely used to manage spasticity in people with SCI under combined electrical stimulation and ultrasound guidance. Further research is required to assess the procedure's safety, efficacy, and cost-effectiveness on patient-reported outcomes compared to other spasticity interventions.
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Affiliation(s)
- Radha Korupolu
- grid.267308.80000 0000 9206 2401Department of Physical Medicine and Rehabilitation, The University of Texas Health Sciences Center at Houston, Houston, TX USA ,grid.414053.70000 0004 0434 8100TIRR Memorial Hermann, Houston, TX USA
| | - Aila Malik
- grid.267308.80000 0000 9206 2401Department of Physical Medicine and Rehabilitation, The University of Texas Health Sciences Center at Houston, Houston, TX USA
| | - Erin Pemberton
- grid.267308.80000 0000 9206 2401Department of Physical Medicine and Rehabilitation, The University of Texas Health Sciences Center at Houston, Houston, TX USA
| | - Argyrios Stampas
- grid.267308.80000 0000 9206 2401Department of Physical Medicine and Rehabilitation, The University of Texas Health Sciences Center at Houston, Houston, TX USA ,grid.414053.70000 0004 0434 8100TIRR Memorial Hermann, Houston, TX USA
| | - Sheng Li
- grid.267308.80000 0000 9206 2401Department of Physical Medicine and Rehabilitation, The University of Texas Health Sciences Center at Houston, Houston, TX USA ,grid.414053.70000 0004 0434 8100TIRR Memorial Hermann, Houston, TX USA
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Hon AJ, Kraus P. Spasticity Management After Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00280-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Tibbett J, Widerström-Noga EG, Thomas CK, Field-Fote EC. Impact of spasticity on transfers and activities of daily living in individuals with spinal cord injury. J Spinal Cord Med 2019; 42:318-327. [PMID: 29334339 PMCID: PMC6522977 DOI: 10.1080/10790268.2017.1400727] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CONTEXT/OBJECTIVE For persons with spinal cord injury, spasticity commonly interferes with activities of daily living such as transfers. Electromyography can be used to objectively measure muscle spasms during transfers, but how electromyographic measures relate to the impact spasticity has on life, or to clinically-rated spasticity, is unclear. We aimed to characterize relationships among spasm duration and magnitude, impact of spasticity on daily life, and a clinical measure of extensor spasticity, as well as to determine reliability of the electromyographic measures. DESIGN Participants (N=19) underwent electromyographic measurements of involuntary muscle activity (spasm duration and magnitude) evoked in quadriceps muscles during transfers on two days. Impact of spasticity on daily life was measured with the Spinal Cord Injury Spasticity Evaluation Tool. Clinically-rated spasticity severity was measured with the Spinal Cord Assessment Tool for Spastic reflexes. RESULTS No significant associations were found between impact of spasticity and spasm duration, spasm magnitude, or clinical extensor spasticity score. Absolute and normalized spasm duration were positively associated with clinical extensor spasticity score (rho=0.510-0.667, P < 0.05). Spasm measures during transfers had good to excellent day-to-day reliability (rho=0.656-0.846, P < 0.05). CONCLUSIONS Electromyographic and clinical measures of involuntary activity in the lower extremity do not significantly relate to perceived impact of spasticity on daily life. However, quadriceps spasm duration during transfers is related to clinically-rated extensor spasticity. Electromyography is a reliable method of quantifying quadriceps spasms during transfers. Future investigations should identify factors that influence the impact of spasticity on life, which may help direct treatment strategies to reduce problematic impact.
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Affiliation(s)
- Jacqueline Tibbett
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida,Department of Physiology and Biophysics, University of Miami, Miami, Florida,Correspondence to: Jacqueline Tibbett, University of Miami Miller School of Medicine, Miami, FL33133, USA; Ph: 305-243-8847.
| | - Eva G. Widerström-Noga
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida,Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Christine K. Thomas
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida,Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Edelle C. Field-Fote
- Shepherd Center, Crawford Research Institute, Atlanta, Georgia,Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia
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Does galvanic vestibular stimulation decrease spasticity in clinically complete spinal cord injury? Int J Rehabil Res 2018; 41:251-257. [PMID: 29889116 DOI: 10.1097/mrr.0000000000000297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The aim of this study was to determine changes in clinical and biomechanical measures of spasticity after administering galvanic vestibular stimulation in patients with a complete spinal cord injury (SCI). The spasticity in the lower limbs was assessed using the Modified Ashworth Scale and the pendulum test in seven SCI patients (grade A on the ASIA Impairment Scale) before (0), immediately after (0), and at 5 and 30 min after the real versus sham galvanic vestibular stimulation (15 s each, anode over the right mastoid). Overall, the changes in spasticity were not significantly different between the real and sham galvanic vestibular stimulation. However, the Modified Ashworth Scale and the pendulum test indicated a reduction in spasticity in two out of seven patients. The results suggest that galvanic vestibular stimulation may modify spasticity in some patients with complete SCI, presumably through the residual vestibulospinal influences. Future studies should determine clinical and neurophysiological profiles of responders versus nonresponders and optimize parameters of galvanic vestibular stimulation.
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Theriault ER, Huang V, Whiteneck G, Dijkers MP, Harel NY. Antispasmodic medications may be associated with reduced recovery during inpatient rehabilitation after traumatic spinal cord injury. J Spinal Cord Med 2018; 41:63-71. [PMID: 27841095 PMCID: PMC5810808 DOI: 10.1080/10790268.2016.1245010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To determine whether antispasmodic medications are associated with neurological and functional outcomes during the first year after traumatic spinal cord injury (SCI). DESIGN/METHODS Retrospective analysis of prospectively collected data from six inpatient SCI rehabilitation centers. Baseline-adjusted outcomes at discharge and one-year follow-up were compared using analysis of covariance between patients who received antispasmodic medication on at least 5 days during inpatient rehabilitation and patients who did not. OUTCOME MEASURES Rasch-transformed motor subscore of the Functional Independence Measure (FIM); International Standards for Neurological Classification of Spinal Cord Injury motor scores, grade, and level. RESULTS Of 1,259 patients, 59.8%, 35.4%, and 4.8% were injured at the cervical, thoracic, and lumbosacral levels, respectively. 65.6% had motor complete injury. Rasch-transformed motor FIM score at admission averaged 23.3 (95% confidence interval (CI) 22.4-24.2). Total motor score averaged 39.2 (95% CI 37.8-40.6). 685 patients (54.4%) received one or more antispasmodic medications on at least 5 days. After controlling for demographic and injury variables at admission, Rasch-transformed motor FIM scores at discharge were significantly lower (P = 0.018) in patients receiving antispasmodic medications than in those who did not. This trend persisted in secondary analyses for cervical, thoracic, and lumbosacral subgroups. Multivariate regression showed that receiving antispasmodic medication significantly contributed to discharge motor FIM outcome. At one-year follow-up, no outcomes significantly differed between patients ON or OFF antispasmodics. CONCLUSIONS Antispasmodic medications may be associated with decreased functional recovery at discharge from inpatient traumatic SCI rehabilitation. Randomized prospective studies are needed to directly evaluate the effects of antispasmodic medication on recovery.
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Affiliation(s)
- Eric R. Theriault
- New York Institute of Technology, Department of Physical Therapy, Old Westbury, NY, USA
| | - Vincent Huang
- Icahn School of Medicine at Mount Sinai, Department of Rehabilitation Medicine, New York, NY, USA
| | | | - Marcel P. Dijkers
- Icahn School of Medicine at Mount Sinai, Department of Rehabilitation Medicine, New York, NY, USA,Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, MI, USA
| | - Noam Y. Harel
- Icahn School of Medicine at Mount Sinai, Department of Rehabilitation Medicine, New York, NY, USA,James J. Peters VA Medical Center, Spinal Cord Damage Research Center, Bronx, NY, USA,Correspondence to: Noam Y. Harel, James J. Peters VA Medical Center, 130 West Kingsbridge Road, 7A-13G, Bronx, NY, 10468; 718-584-9000 x1742.
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A longitudinal study of self-reported spasticity among individuals with chronic spinal cord injury. Spinal Cord 2017; 56:218-225. [DOI: 10.1038/s41393-017-0031-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 12/17/2022]
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Shimizu Y, Kadone H, Kubota S, Suzuki K, Abe T, Ueno T, Soma Y, Sankai Y, Hada Y, Yamazaki M. Voluntary Ambulation by Upper Limb-Triggered HAL® in Patients with Complete Quadri/Paraplegia Due to Chronic Spinal Cord Injury. Front Neurosci 2017; 11:649. [PMID: 29209163 PMCID: PMC5702458 DOI: 10.3389/fnins.2017.00649] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/08/2017] [Indexed: 12/24/2022] Open
Abstract
Patients with complete paraplegia after spinal cord injury (SCI) are unable to stand or walk on their own. Standing exercise decreases the risk of decubitus ulcers, osteoporosis, and joint deformities in patients with SCI. Conventional gait training for complete paraplegia requires excessive upper limb usage for weight bearing and is difficult in cases of complete quadriplegia. The purpose of this study was to describe voluntary ambulation triggered by upper limb activity using the Hybrid Assistive Limb® (HAL) in patients with complete quadri/paraplegia after chronic SCI. Four patients (3 men, 1 woman) were enrolled in this study. The mean patient age ± standard deviation was 37.2 ± 17.8 (range, 20–67) years. Clinical evaluation before intervention revealed the following findings: case 1, neurological level C6, American Spinal Cord Injury Association impairment scale (AIS) grade B; case 2, T6, AIS A; case 3, T10 AIS A; and case 4, T11, AIS A. The HAL intervention consisted of 10 sessions. Each HAL session lasted 60–90 min. The HAL electrodes for hip and knee flexion-extension were placed on the anterior and posterior sides of the upper limbs contralaterally corresponding to each of the lower limbs. Surface electromyography (EMG) was used to evaluate muscle activity of the tensor fascia lata and quadriceps femoris (Quad) in synchronization with a Vicon motion capture system. The modified Ashworth scale (mAs) score was also evaluated before and after each session. All participants completed all 10 sessions. Cases 1, 2, and 3 demonstrated significant decreases in mAs score after the sessions compared to pre-session measurements. In all cases, EMG before the intervention showed no apparent activation in either Quad. However, gait phase dependent activity of the lower limb muscles was seen during voluntarily triggered ambulation driven by upper limb muscle activities. In cases 3 and 4, active contraction in both Quads was observed after intervention. These findings suggest that upper-limb-triggered HAL ambulation is a safe and feasible option for rehabilitation in patients with complete quadri/paraplegia caused by chronic SCI.
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Affiliation(s)
- Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan
| | - Shigeki Kubota
- Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kenji Suzuki
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoyuki Ueno
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yuichiro Soma
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Ikumi A, Kubota S, Shimizu Y, Kadone H, Marushima A, Ueno T, Kawamoto H, Hada Y, Matsumura A, Sankai Y, Yamazaki M. Decrease of spasticity after hybrid assistive limb ® training for a patient with C4 quadriplegia due to chronic SCI. J Spinal Cord Med 2017; 40:573-578. [PMID: 27762171 PMCID: PMC5815155 DOI: 10.1080/10790268.2016.1225913] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CONTEXT Recently, locomotor training with robotic assistance has been found effective in treating spinal cord injury (SCI). Our case report examined locomotor training using the robotic suit hybrid assistive limb (HAL) in a patient with complete C4 quadriplegia due to chronic SCI. This is the first report examining HAL in complete C4 quadriplegia. FINDINGS The patient was a 19-year-old man who dislocated C3/4 during judo 4 years previously. Following the injury, he underwent C3/4 posterior spinal fusion but remained paralyzed despite rehabilitation. There was muscle atrophy under C5 level and no sensation around the anus, but partial sensation of pressure remained in the limbs. The American Spinal Injury Association impairment scale was Grade A (complete motor C4 lesion). HAL training was administered in 10 sessions (twice per week). The training sessions consisted of treadmill walking with HAL. For safety, 2 physicians and 1 therapist supported the subject for balance and weight-bearing. The device's cybernic autonomous control mode provides autonomic physical support based on predefined walking patterns. We evaluated the adverse events, walking time and distance, and the difference in muscle spasticity before and after HAL-training using a modified Ashworth scale (mAs). No adverse events were observed that required discontinuation of rehabilitation. Walking distance and time increased from 25.2 meters/7.6 minutes to 148.3 meter/15 minutes. The mAs score decreased after HAL training. CONCLUSION Our case report indicates that HAL training is feasible and effective for complete C4 quadriplegia in chronic SCI.
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Affiliation(s)
- Akira Ikumi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan,Correspondence to: Akira Ikumi, Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan,Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Hideki Kadone
- Center for Innovating Medicine and Engineering (CIME), University of Tsukuba Hospital, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tomoyuki Ueno
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Hiroaki Kawamoto
- Faculty of Systems and Information Engineering, University of Tsukuba, Ibaraki, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshiyuki Sankai
- Faculty of Systems and Information Engineering, University of Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan,Center for Innovating Medicine and Engineering (CIME), University of Tsukuba Hospital, Ibaraki, Japan
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Ryu Y, Ogata T, Nagao M, Kitamura T, Morioka K, Ichihara Y, Doi T, Sawada Y, Akai M, Nishimura R, Fujita N. The swimming test is effective for evaluating spasticity after contusive spinal cord injury. PLoS One 2017; 12:e0171937. [PMID: 28182676 PMCID: PMC5300247 DOI: 10.1371/journal.pone.0171937] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 01/28/2017] [Indexed: 12/27/2022] Open
Abstract
Spasticity is a frequent chronic complication in individuals with spinal cord injury (SCI). However, the severity of spasticity varies in patients with SCI. Therefore, an evaluation method is needed to determine the severity of spasticity. We used a contusive SCI model that is suitable for clinical translation. In this study, we examined the feasibility of the swimming test and an EMG for evaluating spasticity in a contusive SCI rat model. Sprague-Dawley rats received an injury at the 8th thoracic vertebra. Swimming tests were performed 3 to 6 weeks after SCI induction. We placed the SCI rats into spasticity-strong or spasticity-weak groups based on the frequency of spastic behavior during the swimming test. Subsequently, we recorded the Hoffman reflex (H-reflex) and examined the immunoreactivity of serotonin (5-HT) and its receptor (5-HT2A) in the spinal tissues of the SCI rats. The spasticity-strong group had significantly decreased rate-dependent depression of the H-reflex compared to the spasticity-weak group. The area of 5-HT2A receptor immunoreactivity was significantly increased in the spasticity-strong group. Thus, both electrophysiological and histological evaluations indicate that the spasticity-strong group presented with a more severe upper motor neuron syndrome. We also observed the groups in their cages for 20 hours. Our results suggest that the swimming test provides an accurate evaluation of spasticity in this contusive SCI model. We believe that the swimming test is an effective method for evaluating spastic behaviors and developing treatments targeting spasticity after SCI.
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Affiliation(s)
- Youngjae Ryu
- Department of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
- Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center, Saitama, Japan
| | - Toru Ogata
- Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center, Saitama, Japan
- * E-mail:
| | - Motoshi Nagao
- Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center, Saitama, Japan
| | - Taku Kitamura
- Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center, Saitama, Japan
| | - Kazuhito Morioka
- Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center, Saitama, Japan
- Department of Neurosurgery, Brain and Spinal Injury Center, University of California, San Francisco, California, United States of America
| | - Yoshinori Ichihara
- Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center, Saitama, Japan
| | - Toru Doi
- Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center, Saitama, Japan
| | - Yasuhiro Sawada
- Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center, Saitama, Japan
| | - Masami Akai
- Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center, Saitama, Japan
- Graduate School, International University of Health and Welfare, Tokyo, Japan
| | - Ryohei Nishimura
- Department of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Naoki Fujita
- Department of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
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14
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Kolman S, Spiegel D, Namdari S, Hosalkar H, Keenan MA, Baldwin K. What's New in Orthopaedic Rehabilitation. J Bone Joint Surg Am 2015; 97:1892-8. [PMID: 26582622 DOI: 10.2106/jbjs.o.00827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - David Spiegel
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Surena Namdari
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harish Hosalkar
- Center for Hip Preservation and Children's Orthopedics, Vista, California
| | - Mary Ann Keenan
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keith Baldwin
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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