Spine Cord Injury: An Update

Effect of corporal suspension and pendulum exercises on neuromuscular properties and functionality in patients with medullar thoracic injury

BACKGROUND

Traumatic spinal cord injury (TSCI) is one of the most devastating injuries that has a physical impact on patients. The CHORDATA® method involves suspension and pendulous exercises and has been clinically used to treat patients with TSCI. Although empirically used to treat neurological patients, there is no scientific evidence of the efficacy of this method.

PURPOSE

To evaluate the chronic effects of CHORDATA® method on torque, muscle activation, muscle thickness, and functionality in patients with traumatic spinal cord injury.

METHODS

Twenty-six male patients with medullar thoracic injury were randomly categorised into two groups: intervention group (n = 14) and control group (n = 12). Rehabilitation program comprised of 16 sessions of body suspension and pendulum exercises (twice/week). The maximal voluntary isometric trunk flexion and extension torques, muscle activation and thickness (external and internal oblique, rectus and transversus abdominis, longissimus, and multifidus muscles), and functionality (adapted reach test) were evaluated before and after of rehabilitation program.

FINDINGS

A significant increase was observed in maximal voluntary isometric torque (flexion, 58%; extension, 76%), muscle activation of the rectus abdominis muscle, and muscle thickness of all intervention group muscles, without changes in the control group. Compared to the pre-intervention period, the intervention group also showed improvement in functionality at post-intervention, but no such differences were noted in the control group.

INTERPRETATION

The corporal suspension and pendulum exercises training improved rectus abdominis muscle activation, trunk muscles structure and strength, and reaching capacity in medullar thoracic injury patients.

Mechanism of Neuroprotection Against Experimental Spinal Cord Injury by Riluzole or Methylprednisolone

Any spinal cord injury carries the potential for persistent disability affecting motor, sensory and autonomic functions. To prevent this outcome, it is highly desirable to block a chain of deleterious reactions developing in the spinal areas immediately around the primary lesion. Thus, early timing of pharmacological neuroprotection should be one major strategy whose impact may be first studied with preclinical models. Using a simple in vitro model of the rat spinal cord it is possible to mimic pathological processes like excitotoxicity that damages neurons because of excessive glutamate receptor activation due to injury, or hypoxic/dysmetabolic insult that preferentially affects glia following vascular dysfunction. While ongoing research is exploring the various components of pathways leading to cell death, current treatment principally relies on the off-label use of riluzole (RLZ) or methylprednisolone sodium succinate (MPSS). The mechanism of action of these drugs is diverse as RLZ targets mainly neurons and MPSS targets glia. Even when applied after a transient excitotoxic stimulus, RLZ can provide effective prevention of secondary excitotoxic damage to premotoneurons, although not to motoneurons that remain very vulnerable. This observation indicates persistent inability to express locomotor activity despite pharmacological treatment conferring some histological protection. MPSS can protect glia from dysmetabolic insult, yet it remains poorly effective to prevent neuronal death. In summary, it appears that these pharmacological agents can produce delayed protection for certain cell types only, and that their combined administration does not provide additional benefit. The search should continue for better, mechanism-based neuroprotective agents.

Estudo do perfil do trauma raquimedular em Porto Alegre

Este estudo de coorte retrospectivo foi desenvolvido com o objetivo de traçar o perfil da população que sofreu trauma raquimedular (TRM) e foi internada em hospitais de pronto atendimento de Porto Alegre/RS. O perfil da população que sofreu TRM de janeiro de 2005 a janeiro de 2010 foi investigado retrospectivamente a partir da coleta de dados em registros médicos. Foram analisados 1320 prontuários, dos quais 63,3% eram do sexo masculino, com média de idade de 47,02±19,60 anos. Os mecanismos de TRM que prevaleceram foram queda de altura (27,2%), acidente de trânsito (25,8%) e queda da própria altura (13,2%), e os níveis da coluna vertebral mais acometidos foram lombar (35,6%), torácico (21,9%) e cervical (20,5%). Da amostra total, 10,7% dos indivíduos que sofreram TRM apresentaram lesão medular (LM), com maior prevalência da lesão incompleta (63,3%). O TRM em Porto Alegre acomete principalmente homens na meia-idade, que tiveram na queda de altura a etiologia mais frequente e no nível lombar o mais acometido. A LM ocorreu mais em indivíduos jovens, sendo o nível cervical o mais lesado. Esses achados são importantes para orientar a alocação eficiente de recursos para o manejo desses agravos e suas repercussões e para prevenir a sua ocorrência nas populações em risco.