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Aidinoff E, Elkayam K, Oximitny A, Gur-Pollack R, Groswasser Z, Catz A. Consciousness recovery after various periods in vegetative state. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lerer H, Aidinoff E, Gur-Pollack R, Elkayam K, Catz A. Evaluating changes in stimuli response in the Snoezelen room on minimally responsive patients. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Catz A, Philo O, Gilad N, Barel O, Geva T. Feasibility study of a novel approach to sore prevention in patients with spinal cord lesions: the computerized dynamic control Matrix 200 system. Clin Rehabil 2016. [DOI: 10.1177/026921559901300106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To evaluate the feasibility of a computerized mattress system based on a novel concept in sore prevention: continuous monitoring and adjustment of the interface pressure in small segments of contact between the skin and the supporting surface. Design: A preliminary observational study. Setting: The Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel. Subjects: Twelve patients with spinal cord lesions. Interventions: Patients were examined for signs of impending sores after lying on the mattress for up to 4 successive hours. The pressure within each of the mattress's air cells was continuously measured and adjusted. Results: No evidence of redness or excessive perspiration was found in any of the areas considered to be high risk for bed sores. Maximal interface pressure was 22-30 mmHg in most of the examinations. Most of the patients felt comfortable on the mattress and the staff adapted easily to its operation. Conclusions: The system is apparently safe, and at least as efficient as other existing means for preventing sores. In addition, it may allow for increased intervals between bed positionings. We conclude that this approach of pressure control has the potential to improve bed sore prevention in a rehabilitation hospital setting.
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Affiliation(s)
- A. Catz
- Loewenstein Rehabilitation Hospital, Raanana and Sackler
Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - O. Philo
- Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - N. Gilad
- Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - O. Barel
- Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - T. Geva
- Loewenstein Rehabilitation Hospital, Raanana, Israel
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Aidinoff E, Bluvshtein V, Bierman U, Gelernter I, Front L, Catz A. Coronary artery disease and hypertension in a non-selected spinal cord injury patient population. Spinal Cord 2016; 55:321-326. [PMID: 27431657 DOI: 10.1038/sc.2016.109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 06/07/2016] [Accepted: 06/10/2016] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective observational comparative study. OBJECTIVES The objectives of this study were to assess the atherosclerosis diseases and risk factors prevalence after spinal cored injury (SCI). SETTING Loewenstein Rehabilitation Hospital, Israel. METHODS Data of 154 traumatic and non-traumatic SCI patients were retrospectively collected. Coronary artery disease (CAD), myocardial infarction (MI), hypertension (HT) and risk factors for atherosclerotic diseases were examined after SCI for prevalence and effects, and compared with published corresponding data of the general population. RESULTS CAD, MI and HT were found in 11.7, 6.7 and 29.2% of 120 patients, aged 53.4±11.1 years, 83.3% males, who survived until the end of the follow-up. Corresponding values for the general population, adjusted for age, gender and years of education, are 8.5, 6.6 and 24.9% in Israel, and 10.2% for CAD and 40.3% for HT, in US. Body mass index>30 increased the odds of acquiring CAD (P=0.016). Hypercholesterolemia and older age at injury increased the hazard for HT (P=0.044; P=0.019, respectively). A steady partner decreased the risk of CAD (P=0.029). HT was more prevalent at T4-T6 than above T4 (52 vs 23.3%, P=0.02). Patients with SCI below T6 had a higher rate of diabetes mellitus, hypercholesterolemia, and past smoking, and fewer years of education than those with SCI above T7 (P=0.016; P=0.032; P=0.034; P=0.014, respectively). CONCLUSION The prevalence of CAD, HT and some of their risk factors after SCI is generally, but not consistently and not statistically significant, slightly higher than in the corresponding general population. The challenge is to reduce the prevalence of atherosclerotic morbidity after SCI below that in the general population.
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Affiliation(s)
- E Aidinoff
- Department of Rehabilitation, Sackler Faculty of Medicine, and the Statistical Laboratory, School of Mathematics, Tel Aviv University, Tel Aviv, Israel.,Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - V Bluvshtein
- Department of Rehabilitation, Sackler Faculty of Medicine, and the Statistical Laboratory, School of Mathematics, Tel Aviv University, Tel Aviv, Israel.,Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - U Bierman
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - I Gelernter
- Department of Rehabilitation, Sackler Faculty of Medicine, and the Statistical Laboratory, School of Mathematics, Tel Aviv University, Tel Aviv, Israel
| | - L Front
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - A Catz
- Department of Rehabilitation, Sackler Faculty of Medicine, and the Statistical Laboratory, School of Mathematics, Tel Aviv University, Tel Aviv, Israel.,Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
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Post MW, Charlifue S, Biering-Sørensen F, Catz A, Dijkers MP, Horsewell J, Noonan VK, Noreau L, Tate DG, Sinnott KA. Development of the International Spinal Cord Injury Activities and Participation Basic Data Set. Spinal Cord 2015; 54:530-4. [PMID: 26481708 DOI: 10.1038/sc.2015.188] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 05/23/2015] [Accepted: 05/27/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Consensus decision-making process. OBJECTIVES The objective of this study was to develop an International Spinal Cord Injury (SCI) Activities and Participation (A&P) Basic Data Set. SETTING International working group. METHODS A committee of experts was established to select and define A&P data elements to be included in this data set. A draft data set was developed and posted on the International Spinal Cord Society (ISCoS) and American Spinal Injury Association websites and was also disseminated among appropriate organizations for review. Suggested revisions were considered, and a final version of the A&P Data Set was completed. RESULTS Consensus was reached to define A&P and to incorporate both performance and satisfaction ratings. Items that were considered core to each A&P domain were selected from two existing questionnaires. Four items measuring activities were selected from the Spinal Cord Independence Measure III to provide basic data on task execution in activities of daily living. Eight items were selected from the Craig Handicap Assessment and Reporting Technique to provide basic data on the frequency of participation. An additional rating of satisfaction on a three-point scale for each item completes the total of 24 A&P variables. CONCLUSION Collection of the International SCI A&P Basic Data Set variables in all future research on SCI outcomes is advised to facilitate comparison of results across published studies from around the world. Additional standardised instruments to assess activities of daily living or participation can be administered, depending on the purpose of a particular study.
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Affiliation(s)
- M W Post
- Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation Centre, Utrecht, The Netherlands.,Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - F Biering-Sørensen
- Department for Spinal Cord Injuries, Rigshospitalet and Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A Catz
- Loewenstein Rehabilitation Hospital, Raanana, and Tel-Aviv University, Tel-Aviv, Israel
| | - M P Dijkers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Horsewell
- The European Spinal Cord Injury Federation, Copenhagen, Denmark
| | - V K Noonan
- The Rick Hansen Institute, Vancouver, BC, Canada
| | - L Noreau
- Université Laval and Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, QC, Canada
| | - D G Tate
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
| | - K A Sinnott
- Burwood Academy of Independent Living, Christchurch, New Zealand
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Geyh S, Ballert C, Sinnott A, Charlifue S, Catz A, D'Andrea Greve JM, Post MWM. Quality of life after spinal cord injury: a comparison across six countries. Spinal Cord 2012; 51:322-6. [DOI: 10.1038/sc.2012.128] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Fekete C, Eriks-Hoogland I, Baumberger M, Catz A, Itzkovich M, Lüthi H, Post MWM, von Elm E, Wyss A, Brinkhof MWG. Development and validation of a self-report version of the Spinal Cord Independence Measure (SCIM III). Spinal Cord 2012; 51:40-7. [PMID: 22890418 DOI: 10.1038/sc.2012.87] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional validation study. OBJECTIVES To develop and validate a self-report version of the Spinal Cord Independence Measure (SCIM III). SETTING Two SCI rehabilitation facilities in Switzerland. METHODS SCIM III comprises 19 questions on daily tasks with a total score between 0 and 100 and subscales for 'self-care', 'respiration & sphincter management' and 'mobility'. A self-report version (SCIM-SR) was developed by expert discussions and pretests in individuals with spinal cord injury (SCI) using a German translation. A convenience sample of 99 inpatients with SCI was recruited. SCIM-SR data were analyzed together with SCIM III data obtained from attending health professionals. RESULTS High correlations between SCIM III and SCIM-SR were observed. Pearson's r for the total score was 0.87 (95% confidence interval (CI) 0.82-0.91), for the subscales self-care 0.87 (0.81-0.91); respiration & sphincter management 0.81 (0.73-0.87); and mobility 0.87 (0.82-0.91). Intraclass correlations were: total score 0.90 (95% CI 0.85-0.93); self-care 0.86 (0.79-0.90); respiration & sphincter management 0.80 (0.71-0.86); and mobility 0.83 (0.76-0.89). Bland-Altman plots showed that patients rated their functioning higher than professionals, in particular for mobility. The mean difference between SCIM-SR and SCIM III for the total score was 5.14 (point estimate 95% CI 2.95-7.34), self-care 0.89 (0.19-1.59), respiration & sphincter management 1.05 (0.18-2.28 ) and mobility 3.49 (2.44-4.54). Particularly patients readmitted because of pressure sores rated their independence higher than attending professionals. CONCLUSION Our results support the criterion validity of SCIM-SR. The self-report version may facilitate long-term evaluations of independence in persons with SCI in their home situation.
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Affiliation(s)
- C Fekete
- Swiss Paraplegic Research, Nottwil, Switzerland.
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Drory V, Abraham A, Bronipolsky T, Bluvshtein V, Catz A, Korczyn A. 142. Occurrence of fatigue over 20years after apparent recovery from Guillain–Barré syndrome. Clin Neurophysiol 2012. [DOI: 10.1016/j.clinph.2011.11.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Aidinoff E, Front L, Itzkovich M, Bluvshtein V, Gelernter I, Hart J, Biering-Sørensen F, Weeks C, Laramee MT, Craven C, Hitzig SL, Glaser E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, Masry WSE, Osman A, Glass CA, Soni BM, Gardner BP, Savic G, Bergström EM, Silva P, Catz A. Expected spinal cord independence measure, third version, scores for various neurological levels after complete spinal cord lesions. Spinal Cord 2011; 49:893-6. [DOI: 10.1038/sc.2011.32] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bluvshtein V, Korczyn AD, Pinhas I, Vered Y, Gelernter I, Catz A. Insulin resistance in tetraplegia but not in mid-thoracic paraplegia: is the mid-thoracic spinal cord involved in glucose regulation? Spinal Cord 2010; 49:648-52. [PMID: 21042331 DOI: 10.1038/sc.2010.152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN Controlled experimental human study. OBJECTIVES To assess insulin resistance (IR) in tetraplegia and paraplegia, and the role of the spinal cord (SC) in glucose regulation. SETTING Laboratory of Spinal Research, Loewenstein Rehabilitation Hospital. METHODS Glucose and insulin levels and the heart rate variation spectral components LF (low frequency), HF (high frequency) and LF/HF were studied at supine rest, head-up tilt and after a standard meal in three groups: 13 healthy subjects, 7 patients with T(4)-T(6) paraplegia and 11 patients with C(4)-C(7) tetraplegia. RESULTS Glucose and insulin increased significantly after the meal in all groups (P<0.001). Glucose increased significantly more in the tetraplegia than in the other groups (P<0.01). Increases in insulin level tended to accompany increases in LF/HF after the meal in the tetraplegia and control groups but not in the paraplegia group. CONCLUSION Post-prandial IR appears in C(4)-C(7) but not in T(4)-T(6) SC injury. The results of the study, combined with previously published findings, are consistent with the hypotheses that IR is related to activation of the sympathetic nervous system, and that below T(4) the mid-thoracic SC is involved in the regulation of glucose and insulin levels.
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Affiliation(s)
- V Bluvshtein
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
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Bluvshtein V, Korczyn AD, Akselrod S, Pinhas I, Gelernter I, Catz A. Hemodynamic responses to head-up tilt after spinal cord injury support a role for the mid-thoracic spinal cord in cardiovascular regulation. Spinal Cord 2010; 49:251-6. [PMID: 20714335 DOI: 10.1038/sc.2010.98] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Data showing a role for the mid-thoracic spinal cord (SC) in the control of hemodynamic changes is scarce despite existing evidence for its involvement in autonomic regulation. STUDY DESIGN On the basis of the open label prospective series comparing three groups. OBJECTIVE To determine whether the mid-thoracic SC has a role in hemodynamic regulation during head-up tilt (HUT). SETTING Spinal Research Laboratory, Loewenstein Rehabilitation Hospital. METHODS A total of 13 healthy control subjects, 10 patients with T(4)-T(6) paraplegia and 11 with C(4)-C(7) tetraplegia were examined during supine rest and during HUT. Heart rate (HR), blood pressure (BP), HR spectral components (lower frequency fluctuation (LF), higher frequency fluctuations (HF) and LF/HF) and cerebral blood flow velocity (CBFV) were continuously measured or calculated. RESULTS BP response to HUT differed among these groups (P<0.02). During HUT, BP decreased markedly in the tetraplegia group (from a mean value of 81.65 to 67.69 mm Hg), and increased in the control groups (from 92.89 to 95.44 mm Hg) and in the T(4)-T(6) paraplegia group (from 96.24 to 97.86 mm Hg). Significant correlation was found in the control and tetraplegia groups between increases in HR LF/HF and HR at HUT (r>0.7; P<0.01). No such correlation was found in the paraplegia group. HUT effect on HR and CBFV was significant in all groups (P<0.001), but group differences were statistically non-significant. CONCLUSION Findings were generally compatible with those of comparable previously published studies, but they also support a role for the mid-thoracic SC in hemodynamic regulation, which should be considered in clinical setting and in research.
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Affiliation(s)
- V Bluvshtein
- Department of Spinal Rehabiliation, Loewenstein Rehabilitation Hospital, Raanana, Israel
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Alexander MS, Anderson KD, Biering-Sorensen F, Blight AR, Brannon R, Bryce TN, Creasey G, Catz A, Curt A, Donovan W, Ditunno J, Ellaway P, Finnerup NB, Graves DE, Haynes BA, Heinemann AW, Jackson AB, Johnston MV, Kalpakjian CZ, Kleitman N, Krassioukov A, Krogh K, Lammertse D, Magasi S, Mulcahey MJ, Schurch B, Sherwood A, Steeves JD, Stiens S, Tulsky DS, van Hedel HJA, Whiteneck G. Outcome measures in spinal cord injury: recent assessments and recommendations for future directions. Spinal Cord 2009; 47:582-91. [PMID: 19381157 PMCID: PMC2722687 DOI: 10.1038/sc.2009.18] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Review by the spinal cord outcomes partnership endeavor (SCOPE), which is a broad-based international consortium of scientists and clinical researchers representing academic institutions, industry, government agencies, not-for-profit organizations and foundations. OBJECTIVES Assessment of current and evolving tools for evaluating human spinal cord injury (SCI) outcomes for both clinical diagnosis and clinical research studies. METHODS a framework for the appraisal of evidence of metric properties was used to examine outcome tools or tests for accuracy, sensitivity, reliability and validity for human SCI. RESULTS Imaging, neurological, functional, autonomic, sexual health, bladder/bowel, pain and psychosocial tools were evaluated. Several specific tools for human SCI studies have or are being developed to allow the more accurate determination for a clinically meaningful benefit (improvement in functional outcome or quality of life) being achieved as a result of a therapeutic intervention. CONCLUSION Significant progress has been made, but further validation studies are required to identify the most appropriate tools for specific targets in a human SCI study or clinical trial.
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Itzkovich M, Gelernter I, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, Tonack M, Hitzig SL, Glaser E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, El Masry WS, Osman A, Glass CA, Silva P, Soni BM, Gardner BP, Savic G, Bergström EM, Bluvshtein V, Ronen J, Catz A. The Spinal Cord Independence Measure (SCIM) version III: Reliability and validity in a multi-center international study. Disabil Rehabil 2009; 29:1926-33. [PMID: 17852230 DOI: 10.1080/09638280601046302] [Citation(s) in RCA: 310] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To examine the third version of the Spinal Cord Independence Measure (SCIM III) for reliability and validity in a multi-center cohort study. METHOD Four hundred and twenty-five patients with spinal cord lesions from 13 spinal cord units in six countries from three continents were assessed with SCIM III and the Functional Independence measure (FIM) on admission to rehabilitation and before discharge. RESULTS Total agreement between raters was above 80% in most SCIM III tasks, and all kappa coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.9, and intraclass correlation coefficients were above 0.94. Cronbach's alpha was above 0.7. The coefficient of Pearson correlation between FIM and SCIM III was 0.790 (P<0.01). SCIM III was more responsive to changes than FIM in the subscales of Respiration and sphincter management and Mobility indoors and outdoors. CONCLUSIONS The results support the reliability and validity of SCIM III in a multi-cultural setup. Despite several limitations of the study, the results indicate that SCIM III is an efficient measure for functional assessment of SCL patients and can be safely used for clinical and research trials, including international multi-center studies.
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Affiliation(s)
- M Itzkovich
- Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel
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Fromovich-Amit Y, Biering-Sørensen F, Baskov V, Juocevicius A, Hansen HV, Gelernter I, Hart J, Baskov A, Dreval O, Terese P, Catz A. Properties and outcomes of spinal rehabilitation units in four countries. Spinal Cord 2009; 47:597-603. [PMID: 19172151 DOI: 10.1038/sc.2008.178] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Compare rehabilitation after spinal cord lesions (SCL) in different countries. DESIGN Multicenter comparative study. SETTING Four spinal rehabilitation units, in Denmark, Russia, Lithuania and Israel. SUBJECTS 199 SCL patients. INTERVENTIONS Information was collected about unit properties, rehabilitation objectives, American Spinal Injury Association (ASIA) scale and spinal cord independence measure (SCIM) assessments, and patient data. chi (2)-test, t-test, ANOVA and ANCOVA were used for statistical analysis. MAIN OUTCOME MEASURES Time from lesion onset to admission for rehabilitation (TAR), length of stay in rehabilitation (LOS), SCIM and spinal cord ability realization measurement index (SCI-ARMI) scores, SCIM gain, SCI-ARMI gain and rehabilitation efficiency (RE). RESULTS Differences were found between the units in rehabilitation objectives, facilities and special equipment for rehabilitation. Staff/bed ratio was 1.7 in Lithuania and Denmark, 1.1 in Israel and 0.9 in Russia. Russian patients were the youngest and had the most severe lesions among participating units. Admission SCIM and SCI-ARMI were the lowest in Israel: 25.1+/-17.2 and 34.3+/-17.3. TAR was highest in Russia (12.4 month) and lowest in Israel (2 weeks; P<0.01). LOS was longest in Denmark (176.9 days; P<0.001). SCIM score at the end of rehabilitation was highest in Denmark (67.3+/-23). SCIM gain and SCI ARMI gain were highest in Israel (36.9+/-18.3 and 38.5+/-19.4, respectively) and lowest in Russia (P<0.001). RE was highest in Lithuania and lowest in Denmark (P<0.001). CONCLUSIONS In the participating units, SCL rehabilitation outcomes depend on SCL severity and unit-specific properties. A moderately delayed rehabilitation with long LOS achieved high functioning, and early or slightly delayed rehabilitation combined with shorter LOS achieved high functional gain or efficiency.
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Affiliation(s)
- Y Fromovich-Amit
- The Spinal Department and Medical Management, Loewenstein Rehabilitation Hospital, Ra'anana, Israel
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Catz A, Barkol H, Steinberg F, Ronen J, Bluvshtein V, Keren O. Repeated botulinum toxin injections can improve mobility in patients with spinal cord lesions. Eura Medicophys 2007; 43:319-25. [PMID: 17525702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
AIM The aim of this study was to increase the knowledge about the response to botulinum toxin (BTX) injections to spastic leg muscle motor points (MP) in spinal cord lesion (SCL) patients, and describe improvement of mobility with repeated BTX injections. METHODS Six patients with ASIA grade C or D SCL were studied at the Loewenstein Rehabilitation Center, Israel. The main outcome measures were: modified Ashworth scale scores, range of motion (ROM), and mobility spinal cord independence measure (SCIM) scores. BTX was injected twice within a few weeks' interval to the MP of spastic leg muscles. The outcome measures were monitored before each injection and 2 weeks or more after the second injection. RESULTS Following the first BTX injection the tonus decreased, ROM increased in all 6 patients, and mo- bility functioning improved in 4 of them. Following the repeated injection the tonus further decrea- sed, ROM further improved in 5 of 6 patients, and mobility functions further improved in 4 of 6 patients. CONCLUSION BTX can improve mobility in patients with SCL. Repeated injections may enhance the effect despite the concern for resistance formation. Further research is needed to support the findings and determine the optimal BTX doses and intervals between injections.
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Affiliation(s)
- A Catz
- Spinal Department and Research Laboratory, Loewenstein Rehabilitation Hospital, Raanana, Israel.
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Tchvaloon E, Front L, Gelernter I, Ronen J, Bluvshtein V, Catz A. Survival, neurological recovery and morbidity after spinal cord injuries following road accidents in Israel. Spinal Cord 2007; 46:145-9. [PMID: 17579616 DOI: 10.1038/sj.sc.3102086] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
DESIGN A retrospective cohort study. OBJECTIVE Assess outcomes in patients with spinal cord injuries (SCI) following road accidents, and factors that affect them. SETTING Loewenstein Rehabilitation Hospital, Raanana, Israel. SUBJECTS A total of 143 patients admitted for rehabilitation between 1962 and 2004. METHODS Survival rates were estimated using the product limit (Kaplan-Meyer) method and their association with risk factors was analyzed with the Cox model. Neurological recovery was determined by comparing the Frankel grade at admission to rehabilitation and at discharge. The relation between recovery and various factors was tested with logistic regression. RESULTS The risk of SCI in road accidents is higher among car drivers and motorcycle or bicycle riders. Median survival was 43 years. Survival was negatively associated with age at injury (P<0.0002) and with diagnosis of pressure sores (P=0.0065). Recovery of at least one Frankel grade occurred in 29.1% of patients. Useful recovery (upgrade to Frankel grade D or E) occurred in 23.1% of all patients. Neurological recovery was negatively associated with the severity of neurological deficit (P<0.001) and with thoracic injuries (P=0.046). The most common complications were pressure sores and those of the urinary and respiratory systems. CONCLUSIONS In SCI following road accidents, survival rates were higher and recovery rates lower than in mixed types of trauma. This may be related to better compensation followed by better nursing for road accident victims in Israel, which may prevent life-shortening complications, and to more severe injuries caused by road accidents.
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Affiliation(s)
- E Tchvaloon
- Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel
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Catz A, Bluvshtein V, Pinhas I, Akselrod S, Gelernter I, Nissel T, Vered Y, Bornstein N, Korczyn AD. Cold pressor test in tetraplegia and paraplegia suggests an independent role of the thoracic spinal cord in the hemodynamic responses to cold. Spinal Cord 2007; 46:33-8. [PMID: 17406378 DOI: 10.1038/sj.sc.3102055] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cold application to the hand (CAH) is associated in healthy people with increase in heart rate (HR) and blood pressure (BP). OBJECTIVE To study hemodynamic responses to CAH in humans following spinal cord injuries of various levels, and examine the effect of spinal cord integrity on the cold pressor response. DESIGN An experimental controlled study. SETTING The spinal research laboratory, Loewenstein Hospital, Raanana, Israel. SUBJECTS Thirteen healthy subjects, 10 patients with traumatic T(4-6) paraplegia and 11 patients with traumatic C(4-7) tetraplegia. MAIN OUTCOME MEASURES HR, BP, HR and BP spectral components (low frequency, LF; high frequency, HF; LF/HF), cerebral blood flow velocity (CBFV) and cerebrovascular resistance index (CVRi). METHODS The outcome measures of the three subject groups monitored for HR, BP and CBFV were compared from 5 min before to 5 min after 40-150 s of CAH. The recorded signals were digitized online and analyzed offline in both the time and frequency domains. RESULTS During CAH, HR and CVRi increased significantly in all subject groups (P<0.001), and BP in control subjects and in the tetraplegia group (P<0.01). BP increase was not statistically significant in paraplegia, and CBFV, HR LF, HR HF and BP LF did not change significantly during CAH in any group. CONCLUSIONS The CAH effect in tetraplegia and the suppressed BP increase in paraplegia, supported by the other findings, suggest a contribution of an independent thoracic spinal mechanism to the cold pressor response.
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Affiliation(s)
- A Catz
- The Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel.
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Abstract
BACKGROUND Sleep disturbances are frequent in patients with high spinal cord lesions, and are difficult to diagnose by means of polysomnography (PSG). DESIGN Retrospective cohort study. OBJECTIVE Examine the feasibility of sleep assessment by actigraph in patients with tetraplegia. SETTING A rehabilitation center in Israel. SUBJECTS Twenty-one patients with tetraplegia and 20 healthy persons. INTERVENTIONS Sleep assessment by actigraphs attached to the head and the wrist. MAIN OUTCOME MEASURES The actigraphic movement index (MI), total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), sleep latency (SL), and number of awakenings (NOA). RESULTS In the control group actigraphy showed that during sleep the hand moves more than the head but that the movements were highly correlated. In patients with tetraplegia below C(5)-C(7) the hand also moved more than the head, but in patients with tetraplegia below C(4), the head moved more (P<0.05). No significant differences were found between patients with C(5)-C(7) tetraplegia and healthy controls in the sleep indices obtained by hand movements, or between patients with C(4) tetraplegia and healthy controls in the indices obtained by head movements. Control subjects and patients showed similar subjective assessment of sleep quality. CONCLUSIONS These preliminary findings support the validity of wrist actigraphy for sleep assessment in patients with C(5)-C(7) tetraplegia, and suggest that head-mounted actigraphy is a feasible alternative for sleep assessment in patients with tetraplegia below C(4). To establish these findings, further investigations are required, with a larger number of patients and comparison with PSG.
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Affiliation(s)
- E Spivak
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
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Spivak E, Keren O, Niv D, Levental J, Steinberg F, Barak D, Chen B, Zupan A, Catz A. Electromyographic signal-activated functional electrical stimulation of abdominal muscles: the effect on pulmonary function in patients with tetraplegia. Spinal Cord 2007; 45:491-5. [PMID: 17325697 DOI: 10.1038/sj.sc.3102039] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Paralysis of abdominal muscles is the main cause of respiratory dysfunctions in patients with lower cervical spinal cord lesion. Activation of the abdominal muscles using functional electrical stimulation (FES) improved respiratory function in these patients. But application of FES frequently requires a caregiver, and it may not be well synchronized with the patient's respiratory activity. OBJECTIVE To perform preliminary examination of electromyographic (EMG)-activated FES for caregiver-independent and synchronized cough and expiration induction in tetraplegia. DESIGN Self-controlled study. SETTING Loewenstein Rehabilitation Center, Raanana, Israel. SUBJECTS A total of 10 male patients with complete or almost complete tetraplegia. MAIN OUTCOME MEASURES Peak expiratory flow (PEF), forced vital capacity (FVC), and maximal voluntary ventilation (MVV). METHODS The outcome measures were examined with the abdominal muscles unassisted or assisted by various methods. These included manual assistance or application of FES, activated by a caregiver, by the patient, or by EMG signals elicited from the patient's muscle. RESULTS Manual assistance improved the mean PEF value by 36.7% (P<0.01) and the mean FVC value by 15.4% (P=0.01). FES did not significantly change most measurements, and patient-activated FES even reduced PEF (P<0.05). But following EMG-activated FES PEF and FVC values were higher than those following patient-activated FES (P<0.05 for PEF; P<0.01 for FVC), and their mean values were higher by 15.8 and 18.9%, respectively. CONCLUSIONS Abdominal FES failed to improve respiratory function in this study, but applying FES to abdominal muscles by EMG from the patient's muscle may promote caregiver-free respiration and coughing in persons with cervical SCL.
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Affiliation(s)
- E Spivak
- Loewenstein Rehabilitation Hospital, Raanana, Israel
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22
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Catz A, Itzkovich M, Tesio L, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, Tonack M, Hitzig SL, Glaser E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, El Masry WS, Osman A, Glass CA, Silva P, Soni BM, Gardner BP, Savic G, Bergström EM, Bluvshtein V, Ronen J. A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation. Spinal Cord 2006; 45:275-91. [PMID: 16909143 DOI: 10.1038/sj.sc.3101960] [Citation(s) in RCA: 211] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A third version of the Spinal Cord Independence Measure (SCIM III), made up of three subscales, was formulated following comments by experts from several countries and Rasch analysis performed on the previous version. OBJECTIVE To examine the validity, reliability, and usefulness of SCIM III using Rasch analysis. DESIGN Multicenter cohort study. SETTING Thirteen spinal cord units in six countries from North America, Europe, and the Middle-East. SUBJECTS 425 patients with spinal cord lesions (SCL). INTERVENTIONS SCIM III assessments by professional staff members. Rasch analysis of admission scores. MAIN OUTCOME MEASURES SCIM III subscale match between the distribution of item difficulty grades and the patient ability measurements; reliability of patient ability measures; fit of data to Rasch model requirements; unidimensionality of each subscale; hierarchical ordering of categories within items; differential item functioning across classes of patients and across countries. RESULTS Results supported the compatibility of the SCIM subscales with the stringent Rasch requirements. Average infit mean-square indices were 0.79-1.06; statistically distinct strata of abilities were 3 to 4; most thresholds between adjacent categories were properly ordered; item hierarchy was stable across most of the clinical subgroups and across countries. In a few items, however, misfit or category threshold disordering were found. CONCLUSIONS The scores of each SCIM III subscale appear as a reliable and useful quantitative representation of a specific construct of independence after SCL. This justifies the use of SCIM in clinical research, including cross-cultural trials. The results also suggest that there is merit in further refining the scale.
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Affiliation(s)
- A Catz
- Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel
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23
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Catz A, Bluvshtein V, Pinhas I, Akselrod S, Gelernter I, Nissel T, Vered Y, Bornstein NM, Korczyn AD. Hemodynamic effects of liquid food ingestion in mid-thoracic paraplegia: is supine postprandial hypotension related to thoracic spinal cord damage? Spinal Cord 2006; 45:96-103. [PMID: 16850007 DOI: 10.1038/sj.sc.3101939] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Postprandial hypotension (PPH) appears in various conditions with autonomic failure and was symptomatic in a patient with thoracic paraplegia, but was not remarkable in patients with tetraplegia. OBJECTIVE To determine whether the pathology causing PPH may include a thoracic but not a cervical spinal cord lesion (SCL). DESIGN An experimental controlled study. SETTING The spinal research laboratory, Loewenstein Hospital, Raanana, Israel. SUBJECTS Thirteen healthy subjects, 10 patients with traumatic T(4)-T(6) paraplegia, and 11 patients with traumatic C(4)-C(7) tetraplegia. MAIN OUTCOME MEASURES Heart rate (HR), blood pressure (BP), HR and BP spectral components (LF, HF, LF/HF), cerebral blood flow velocity (CBFV), and cerebrovascular resistance index (CVRi). METHODS The effects of a standard liquid meal on the outcome measures were compared between the three subject groups monitored for HR, BP, and CBFV, from 55 min before to 45 min after the start of the meal. The recorded signals were digitized online and analyzed off-line in the time and frequency domains. RESULTS After meal, BP decreased only in the paraplegia group (P<0.01), HR increased more prominently in this group (P<0.01), CVRi tended to decrease only in the paraplegia group, CBFV did not change significantly in any group, and HR LF/HF increased (P<0.001) in all groups but tended to increase more in paraplegia. CONCLUSIONS Patients with mid-thoracic SCL may develop PPH. The pathology causing PPH can include a thoracic but not a cervical SCL. The normal hemodynamic reaction to liquid meal ingestion is mediated through the mid-thoracic spinal cord. The sympathovagal balance increases after food ingestion, more prominently in patients with PPH, and cerebrovascular resistance changes during PPH may help maintain the cerebral circulation.
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Affiliation(s)
- A Catz
- Department IV, Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, 278 Achuza Street, Raanana 43100, Israel
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24
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Polliack T, Bluvshtein V, Philo O, Ronen J, Gelernter I, Luttwak ZP, Hart J, Catz A. Clinical and economic consequences of volume- or time-dependent intermittent catheterization in patients with spinal cord lesions and neuropathic bladder. Spinal Cord 2005; 43:615-9. [PMID: 15968307 DOI: 10.1038/sj.sc.3101751] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Open comparative study. OBJECTIVE To compare the impact of volume-dependent intermittent catheterization (VDIC) and time-dependent intermittent catheterization (TDIC) on financial burden and clinical outcomes in patients with spinal cord lesions (SCL). SETTING Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Israel. METHOD Economic and clinical outcomes were examined in 13 SCL patients treated with VDIC following bladder volume measurement by a portable ultrasound device (the study group), and in 11 patients treated with TDIC (the control group). Patients were followed for 12-30 days. Costs were calculated according to December 2003 prices at Loewenstein Hospital. The t-test and the Fisher's Exact Test were employed for comparisons between the groups. RESULTS The number of catheterizations per patient per day, the time required to perform volume measurements and catheterizations, and their total cost, were approximately 44, 49, and 46% lower in the study group than in the control group. SCIMU (representing bladder management functioning) increased during the study in both groups, and the increase was 31% higher in the study group than in the control group. Urinary infection was found in three patients in the control group and in none in the study group. CONCLUSION VDIC has economic and probably also clinical advantages over TDIC.
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Affiliation(s)
- T Polliack
- Loewenstein Rehabilitation Hospital, Raanana, Israel
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25
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Abstract
OBJECTIVE To report a case of Carbamazepine toxicity following the administration of Oxybutynin and Dantrolene. STUDY DESIGN A case report. SETTING The Spinal Rehabilitation Department, Loewenstein Hospital, Raanana, Israel. METHODS A patient with C6D tetraplegia who sustained intoxication because of drug interaction is presented. She had been treated by Carbamazepine 1000 mg/day for neuropathic pain for 2 years without clinical or laboratory signs of toxicity. After administration of Oxybutynin concomitantly with an increase in the dose of Dantrolene, she presented the clinical symptoms and laboratory finding of Carbamazepine intoxication. Trying to adjust the treatment to the patient's requirements, Carbamazepine together with Oxybutynin and Dantrolene was readministrated in lower doses. RESULTS The combination of these drugs, even small doses, caused toxicity. Adding Dantrolene and Oxybutynin elevated the blood level of Carbamazepine, possibly by inhibition of cytochrome P450. CONCLUSION A possible pharmacokinetic interaction between Dantrolene and Oxybutynin should be borne in mind when considering Carbamazepine medication for a patient with a spinal cord lesion.
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Affiliation(s)
- T Vander
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
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26
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Abstract
The prevalence of obesity among the population is increasing, including in many elderly people. The purpose of this study was to evaluate whether lumbar spinal surgery in elderly patients with different body mass indices influences pain, satisfaction rate, and activities of daily living. Two hundred ninety-eight elderly patients (older than 65 years), 153 women and 145 men, who had decompressive laminectomy, discectomy, or combinations of these procedures during 1990 to 2000 were followed up. Indications for surgery included limitation in doing activities of daily living, severe pain, or both. The patients were classified into one of four categories in terms of their body mass index. The operative parameters, pain reduction, satisfaction rate, and activities of daily living using the Barthel index were assessed. The more obese patients were younger, tended to be female, and were more symptomatic. All four groups of patients had reduction in pain, improvement in activities of daily living, and were satisfied with the operation. Our data suggest that it is reasonable to operate on patients who are elderly and obese and who have lumbar symptoms, with the appropriate indications.
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Affiliation(s)
- R Gepstein
- Spinal Care Unit, Sapir Medical Center, Kfar-Saba, Israel
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27
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Ronen J, Goldin D, Itzkovich M, Bluvshtein V, Gelernter I, Gepstein R, David R, Livshitz A, Catz A. Outcomes in patients admitted for rehabilitation with spinal neurological lesions following intervertebral disc herniation. Spinal Cord 2004; 42:621-6. [PMID: 15289802 DOI: 10.1038/sj.sc.3101642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Little information is available about the survival, neurological recovery, and length of stay in hospital for rehabilitation (LOS) of patients with spinal neurological deficit following disc herniation (DH). STUDY DESIGN Retrospective cohort study. OBJECTIVE To report on outcomes and factors affecting these. SETTING The Spinal Research Laboratory, Loewenstein Rehabilitation Hospital, Israel. SUBJECTS A total of 158 patients with DH spinal neurological lesions (DHSNL). METHOD Data were collected retrospectively. Survival was assessed using the Kaplan-Meier method; relative mortality risk by the Cox proportional hazard model. Neurological recovery was evaluated by calculating the change in Frankel grades, and factors that affect it were assessed by logistic regression. LOS associations were analyzed with ANOVA. RESULTS The median age at lesion onset was 48 years, and the median survival 29 years. Age and gender had a significant effect on survival, but not so lesion severity, level, or decade of onset. Of the 69 patients who had Frankel grades A, B, or C on admission, 72% achieved useful recovery to grades D or E. The severity and level of the spinal neurological lesion (SNL) had a significant effect on recovery. The mean LOS was 87 days; it was significantly affected by lesion severity and level and by the decade of admission to rehabilitation, and decreased with time. CONCLUSIONS Patients with DHSNL who were admitted for rehabilitation have favorable survival and recovery rates compared with previously studied patients with other types of SNL. Their LOS is probably a function of medical requirements, but is decreasing with time.
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Affiliation(s)
- J Ronen
- Spinal Research Laboratory, Loewenstein Rehabilitation Hospital, Raanana, Israel
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Livshits A, Catz A, Folman Y, Witz M, Livshits V, Baskov A, Gepstein R. Reinnervation of the neurogenic bladder in the late period of the spinal cord trauma. Spinal Cord 2004; 42:211-7. [PMID: 15060517 DOI: 10.1038/sj.sc.3101574] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Intercostal nerve to spinal nerve root anastomosis in chronic spine-injured patients. OBJECTIVES To analyze the effectiveness of neurogenic bladder reinnervation in spinal cord-injured patients through artificial creation of sprouting (intercostal nerve to spinal nerve root anastomosis). SETTING Center of Neurosurgery, Moscow, Russia. Operations were performed by Professor A Livshits. (At present, Professor A Livshits is working at the Spinal Care Unit, Meir General Hospital, Kfar Saba, Israel.) METHODS A total of 11 patients with spinal cord injury of the L1 level were operated on in the late (chronic) stage. The neurological status and urodynamics were investigated before and 12 months after operation. A laminectomy from T11 to L3 was performed. Next, a neurolysis of the 11th and 12th intercostal nerves was carried out, at a distance of 20-21 cm, and transferred to the vertebral canal. The S2-S3 roots were then cut in their proximal portion and anastomosed end-to-end to the intercostal nerves. The results of urodynamic studies were calculated by the Wilcoxon signed rank test for comparison before and 12 months after operation. RESULTS OF URODYNAMIC STUDIES: Bladder capacity (ml) before operation - 489+/-79, after operation - 350+/-39, urine volume (ml) before - 18.2+/-17, after - 306.4+/-39.8, residual urine (ml) before - 459+/-99.4, after - 50+/-11.8. Detrusor tone (rel. units) before - 0.6+/-1.5, after 1.2+/-0.2; voiding pressure (cmH(2)O) before - 4.4+/-5.2, after - 30.5+/-4.9. Force of detrusor contraction before - 5+/-5.8, after - 32.8+/-5.5. Sphincter resistance (cmH(2)O) before - 6.5+/-3.8, after - 21.1+/-4.2. Significant improvements in bladder function were observed during the 10th to 12th postoperative months. Restoration of reflex voiding occurred in all patients; in eight of the 11 paresthesic in the groin and scrotum and reappearance of the bulbocavernous, anal and cremasteric reflexes were noted. CONCLUSION These results suggest that a restitutive process occurs in the bladder under novel conditions of its nerve supply provided by the intercostal nerve and by new connections established between it and the bladder nerves. Spinal cord lesions that might benefit from nerve crossover surgery would be located at the conus, so functional intercostal nerves could be connected to sacral roots to bypass the injury in an attempt to restore central connections to the bladder.
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Affiliation(s)
- A Livshits
- The Spinal Care Unit, Meir General Hospital, Kfar Saba, Israel
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29
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Ronen J, Itzkovich M, Bluvshtein V, Thaleisnik M, Goldin D, Gelernter I, David R, Gepstein R, Catz A. Length of stay in hospital following spinal cord lesions in Israel. Spinal Cord 2004; 42:353-8. [PMID: 14968104 DOI: 10.1038/sj.sc.3101590] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To monitor length of stay (LOS) in a specialist spinal cord lesion (SCL) department in Israel, evaluate factors that affect it, and assess its association with other outcome measures. SETTING Loewenstein Rehabilitation Hospital, Raanana, Israel. METHODS In all, 1367 SCL patients treated between 1962 and 2000, and a group of 44 patients admitted between 1996 and 2002 were recruited. LOS, factors that affect it, and Spinal Cord Independence Measure second version (SCIM-II) gain and efficiency were measured. Data were collected from hospital charts and from the Population Registry of the Israel Ministry of Internal Affairs. LOS associations were analyzed with ANOVA, ANCOVA, Pearson's chi(2) test, Pearson's correlation, and Cox proportional hazard model. RESULTS The mean LOS was 239 days for traumatic SCL (SD=168) and 106 days for non-traumatic SCL (SD=137). SCL etiology, SCL severity, and decade of admission to rehabilitation, were associated with the LOS (P<0.001). SCIM II gain correlated with LOS in the first 70 days after admission (r=0.81-0.82; P<0.001). In some patients, longer LOS was associated with a considerable increase in ability, through 5-8 months from admission. CONCLUSIONS LOS of patients with SCL in Israel is within the customary LOS range in Europe. Longer LOS in a specialist SCL department may be positively associated with improved rehabilitation outcome. Further study is required to determine the LOS that allows optimal achievements.
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Affiliation(s)
- J Ronen
- Loewenstein Rehabilitation Hospital, Raanana, Israel
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30
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Pevsner Y, Shabat S, Catz A, Folman Y, Gepstein R. The role of radiofrequency in the treatment of mechanical pain of spinal origin. Eur Spine J 2003; 12:602-5. [PMID: 14586665 PMCID: PMC3467995 DOI: 10.1007/s00586-003-0605-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2003] [Revised: 07/15/2003] [Accepted: 07/19/2003] [Indexed: 11/27/2022]
Abstract
Radiofrequency (RF) ablation is a method that has been gaining popularity over the past few years among spinal surgeons. It has a role when dealing with pain of spinal origin, either mechanical or neuropathic, after conservative treatment has failed. In the present study, 122 patients with a minimal follow up of 1 year were examined at our institution after having undergone RF heat lesion of the medial branch for mechanical spinal pain (low back pain, thoracic pain or cervical pain). They were followed up 1, 3, 6 and 12 months after treatment. Twenty-two of them were additionally followed up at 18 months. After 1 month, 91 patients (75%) were satisfied with the results. After 3 months, 87 patients (71%) had significant pain relief, while in 35 patients (29%) there was no improvement. After 6 months of follow-up, 80 patients (66%) had pain relief and in 42 patients (34%) there was no effect. At 12-months follow-up, 77 patients (63%) showed good results and 45 patients (37%) had no effect. In the case of the 22 patients who were followed for 18 months, all showed significant pain relief. Minor complications occurred in 27 patients (22%), who had transient discomfort and burning pain. We concluded that RF is a safe and partially effective procedure for mechanical back pain.
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Affiliation(s)
- Y. Pevsner
- The Spine Unit, Sapir Medical Center, 48 Tchernichovsky St., 44281 Kfar-Saba , Israel
- Tel-Aviv Sackler Medical School, Tel-Aviv, Israel
| | - S. Shabat
- The Spine Unit, Sapir Medical Center, 48 Tchernichovsky St., 44281 Kfar-Saba , Israel
- Tel-Aviv Sackler Medical School, Tel-Aviv, Israel
| | - A. Catz
- Lowenstein Hospital for Rehabilitation, Kfar-Saba, Israel
| | - Y. Folman
- Department of Orthopaedic Surgery, Hillel-Yafe Medical Center, Hadera, Israel
| | - R. Gepstein
- The Spine Unit, Sapir Medical Center, 48 Tchernichovsky St., 44281 Kfar-Saba , Israel
- Tel-Aviv Sackler Medical School, Tel-Aviv, Israel
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David R, Folman Y, Pikarsky I, Leitner Y, Catz A, Gepstein R. Harvesting bone graft from the posterior iliac crest by less traumatic, midline approach. J Spinal Disord Tech 2003; 16:27-30. [PMID: 12571481 DOI: 10.1097/00024720-200302000-00005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Complications of the donor site after the harvest of corticocancellous bone graft from the posterior iliac crest are very common. The most common are chronic donor site pain, tenderness, and sensory disturbances. This study investigates the results of the midline, lumbar fascia splitting approach for harvesting bone graft in lower lumbar spine fusion and compares them with the classic separate incision approach. A retrospective study of 107 patients compares two groups. The first group of 56 patients (35 males and 21 females with an average age of 41.8 years) had bone graft taken by splitting the two layers of the lumbar fascia down to their attachment to the iliac crest. The second group of 51 patients (29 males and 22 females with an average age of 43.7 years) had a separate incision over the iliac crest. In the first group, 82.1% had no tenderness, 8.9% mild, 7.1% moderate, and only 1.8% severe tenderness over the donor site. In the second group, 45.1% had no tenderness, 21.6% mild, 17.6% moderate, and 15.7% severe tenderness over the donor site. Five patients of the separate incision group (9.8%) had a lump in the donor site compared with none in the "same incision" group. Sensory disturbances over the donor site were found in 5.4% of the first group and in 21.6% of the second group. Harvesting bone graft from the posterior iliac crest for lower lumbar spine fusion through a midline, fascia splitting approach was found superior to the traditional, separate incision approach.
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Affiliation(s)
- R David
- Spinal Care Unit, Meir Medical Center, Kfar Sava, Israel
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Abstract
BACKGROUND Survival following spinal cord injury (SCI) has greatly improved since the unsuccessful attempts to repair the damaged spinal cord were replaced by systematic prevention and treatment of complications caused by the neural damage. OBJECTIVE To evaluate the main outcome measures in patients with spinal cord injury. DESIGN Retrospective cohort study. SETTING Loewenstein Rehabilitation Hospital, the major referral center for rehabilitation medicine for hospitals throughout Israel. SUBJECTS 250 consecutive patients, injured between 1959 and 1992. MAIN OUTCOME MEASURES Survival rates and mortality risk factors. METHOD Demographic, clinical, and mortality data were collected from the hospital charts and from the Population Registry of the Israel Ministry of Internal Affairs. Survival rates were estimated using the product limit (Kaplan-Meyer) method, and their association with known risk factors was analyzed with the Cox proportional hazard model. RESULTS The survival rate after injury was 81% after 10 years, 75% after 20 years, and 62% after 30 years, and 50% after about 36.5 years. Survival was found to be negatively associated with age (P=0.01) and with high spinal level of injury (P=0.003). CONCLUSIONS Survival rates in the studied population are similar to those reported in other countries, and are close to those of the general population living in Israel in the same time period. The study demonstrates that developing countries can reach survival rates comparable to those of developed countries, and may contribute to better survival predictions of patients with SCI.
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Affiliation(s)
- A Catz
- Loewenstein Rehabilitation Hospital, Raanana, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Itzkovich M, Tripolski M, Zeilig G, Ring H, Rosentul N, Ronen J, Spasser R, Gepstein R, Catz A. Rasch analysis of the Catz-Itzkovich spinal cord independence measure. Spinal Cord 2002; 40:396-407. [PMID: 12124666 DOI: 10.1038/sj.sc.3101315] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Spinal Cord Independence Measure (SCIM) is a new disability scale developed specifically for patients with spinal cord lesions (SCL). Its original and second versions (SCIM and SCIM II) were found to be reliable and more sensitive than the Functional Independence Measure (FIM) to functional changes in SCL patients. OBJECTIVE To further validate the SCIM II, examining its components on a larger population. DESIGN Retrospective cohort study. SETTING Two rehabilitation centers in Israel. SUBJECTS Two hundred and two inpatients with SCL. INTERVENTIONS Routine SCIM assessments by staff nurses. Rasch and accompanying analyses. MAIN OUTCOME MEASURES Unidimensionality of subscales (areas of function); goodness of fit of the tasks to the Rasch model; relationship of total-patient and single-task performance-ability; usability of task categories and the order of threshold locations between them; subscale discrimination of ability and difficulty and hierarchical nature; discrimination of task-categories ability, ie, distribution of thresholds along ability levels; and differential task behavior by age, gender and examination subgroups. RESULTS Four unidimensional subscales were identified, and an acceptable goodness of fit to the Rasch model was demonstrated in most of their tasks (infit mean square=0.8-1.2, outfit mean square=0.6-1.4). However, some tasks showed overfit (bathing lower body) and some showed misfit (wheelchair-car transfer). Additional analyses performed to check for reasons for less than acceptable fit revealed flaws in a minority of the outcome measures. CONCLUSIONS The findings of this analysis confirm the validity and reliability of the SCIM II. To a large extent we can infer that the SCIM II construct allows for the detection of any level of disability in any patient with SCL. A few item categories, however, should be rephrased or removed.
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Affiliation(s)
- M Itzkovich
- Loewenstein Rehabilitation Hospital, Raanana, Israel
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Catz A, Sagiv M. [Respiratory impairments and aerobic physical activity in low-cervical spinal cord injuries]. Harefuah 2001; 140:850-4. [PMID: 11579737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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35
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Catz A, Itzkovich M, Steinberg F, Philo O, Ring H, Ronen J, Spasser R, Gepstein R, Tamir A. The Catz-Itzkovich SCIM: a revised version of the Spinal Cord Independence Measure. Disabil Rehabil 2001; 23:263-8. [PMID: 11336099 DOI: 10.1080/096382801750110919] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE To examine the suitability of the revised Spinal Cord Independence Measure, the Catz-ltzkovich SCIM, for evaluation of patients with spinal cord lesions, as compared to the original SCIM and to the Functional Independence Measure (FIM). METHOD The revised SCIM was applied by paired independent teams of occupational therapists, physiotherapists and nurses and the FIM by a single nurse. The examiners assigned scores to the functional capabilities of 28 patients with spinal cord lesions. The scores by the revised SCIM were analysed for reproducibility as between the two teams of examiners (interrater reliability) and for their correlation with the FIM scores. RESULTS The frequency of identical scoring by two independent examiners (total agreement) was 80% or higher for 13/18 individual functions listed in the revised SCIM. In the self-care category it was 80-99%, as compared to 75-87% before revision. In neither bowel management nor bed mobility was there an increase over the original SCIM in the frequency of identical scores, despite rephrasing and restructuring of the scoring criteria. A high correlation was noted between the paired scores for all functions listed as well as for those comprising each of the four functional categories (r = 0.90-0.96, p <0.001). The total revised-SCIM scores were significantly correlated with those derived by the FIM (r = 0.835, p < 0.001). CONCLUSIONS The findings indicate that the newly revised SCIM (Catz-Itzkovich) is a valid and highly reproducible measure of daily function in patients with spinal cord lesions, and is superior to the original SCIM. We recommend that it supersede the original SCIM.
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Affiliation(s)
- A Catz
- Department of Spinal Rehabilitation, Loewenstein Hospital, Raanana, Israel.
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Itzkovich M, Catz A, Tamir A, Ronen J, Philo O, Steinberg F, Tabacaru E, Spasser R, Gepstein R. Spinal pain independence measure--a new scale for assessment of primary ADL dysfunction related to LBP. Disabil Rehabil 2001; 23:186-91. [PMID: 11336375 DOI: 10.1080/09638280151080540] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE/METHOD SPIM Spinal Pain Independence Measure. a new disability scale designed for patients with chronic low back pain disability, has been developed and studied at the Spinal Department of Loewenstein Rehabilitation Hospital. The SPIM differs from other existing scales for evaluation of chronic back disability, in that it is designated particularly for patients with deficits in primary ADL and evaluates function by observation. RESULTS/CONCLUSIONS This study shows the SPIM to be reliable: it supports the validity of the scale and points out a possible advantage of the SPIM over existing scales in sensitivity to functional change of patients with prominent disability. Further elaboration and examination of the SPIM is still needed.
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Catz A, Shapira Y. [Aging and thermoregulation]. Harefuah 2001; 140:253-7. [PMID: 11303355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Catz A, Itzkovich M, Agranov E, Ring H, Tamir A. The spinal cord independence measure (SCIM): sensitivity to functional changes in subgroups of spinal cord lesion patients. Spinal Cord 2001; 39:97-100. [PMID: 11402366 DOI: 10.1038/sj.sc.3101118] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The spinal cord independence measure (SCIM) is a newly developed disability scale specific to patients with spinal cord lesions (SCL). Its sensitivity to functional changes in a whole cohort of SCL patients was found to be better than that of the functional independence measure (FIM). OBJECTIVE o compare the sensitivity to functional changes of the SCIM and the FIM in SCL subgroups. DESIGN A comparative self-controlled study. SETTING The Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel. SUBJECTS 22 SCL inpatients. INTERVENTIONS Monthly SCIM and FIM assessments of the subgroups. MAIN OUTCOME MEASURES Functional change detection rate (FDR) and mean differences between consecutive scores (DCS). RESULTS The outcome measures of the SCIM were higher than those of the FIM for tetraplegia and paraplegia, complete and incomplete lesions (the FIM missed 25-27% of the functional changes detected by the SCIM; DSC 8.2-11.4 vs 5.2-9; P<0.05 in most comparisons). The SCIM did not exhibit this advantage, however, in the functional areas of self-care and mobility in the room and toilet. Further subgrouping yielded similar results. CONCLUSIONS The SCIM is more sensitive than the FIM to functional changes in the subgroups studied, and has the potential to serve as a universal tool for disability assessment of SCL patients.
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Affiliation(s)
- A Catz
- Loewenstein Rehabilitation Hospital, Raanana and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Keren O, Shinberg F, Catz A, Giladi N. [Botulin toxin for spasticity in spinal cord damage by treating the motor endplate]. Harefuah 2000; 138:204-8, 270. [PMID: 10883093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Therapeutic injection of botulin toxin is well-recognized for reducing tonus in local dystonia. However, its efficacy in reducing spasticity in spinal cord injuries is still unproven. 4 men and 1 woman (mean age 39 years, range 20-56) with spinal cord injury and debilitating spasticity, and no response to standard treatment for spasticity received injections of botulin, 200-300 U, into 4-8 points in their legs to block muscle-nerve synapses. In all 5 tonus was reduced in the area of the block, while in some it was also reduced in more distal muscles. In 1 there was reduced tonus in both the injected and contralateral leg. The therapeutic effect on tonus persisted for 3 months. In spite of objective improvement in tonus in all 5, only 3 felt subjective improvement, but in none was there improvement on standard functional scaling. We found injection of botulin toxin effective in reducing tonus in the spinal cord-injured, and to some extent in improving subjective feeling of well-being in some of them. Objective measurement might show functional improvement after larger doses of toxin injected into more muscles. This might be necessary because the muscle mass of the legs is large and the intensity of involuntary contraction is especially high in these patients.
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Affiliation(s)
- O Keren
- Loewenstein Rehabilitation Hospital, Ra'anana
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Abstract
PURPOSE The aim of the present study was to compare the functional effect of conservative and surgical treatment in post-traumatic syringomyelia. METHOD The files of 10 male patients treated for posttraumatic syringomyelia were retrospectively reviewed from 1986 to 1996. RESULTS The spinal lesion was complete in five patients and incomplete in five. All patients underwent rehabilitation, five of them following surgery. The operative procedures included drainage by syringosubarachnoid shunting (four patients) and decompressive laminectomy (one patient). Rehabilitation alone improved the functional status in all five patients so treated. After surgery, function deteriorated in four of the five operated patients, and rehabilitation failed to restore the preoperative functional status in any of them. CONCLUSION In view of the results it is suggested that patients with post-traumatic syringomyelia undergo rehabilitation with very close clinical and magnetic resonance imaging follow-up.
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Affiliation(s)
- J Ronen
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
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Catz A, Philo O, Gilad N, Barel O, Geva T. Feasibility study of a novel approach to sore prevention in patients with spinal cord lesions: the computerized dynamic control Matrix 200 system. Clin Rehabil 1999; 13:44-7. [PMID: 10327096 DOI: 10.1191/026921599701532117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the feasibility of a computerized mattress system based on a novel concept in sore prevention: continuous monitoring and adjustment of the interface pressure in small segments of contact between the skin and the supporting surface. DESIGN A preliminary observational study. SETTING The Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel. SUBJECTS Twelve patients with spinal cord lesions. INTERVENTIONS Patients were examined for signs of impending sores after lying on the mattress for up to 4 successive hours. The pressure within each of the mattress's air cells was continuously measured and adjusted. RESULTS No evidence of redness or excessive perspiration was found in any of the areas considered to be high risk for bed sores. Maximal interface pressure was 22-30 mm Hg in most of the examinations. Most of the patients felt comfortable on the mattress and the staff adapted easily to its operation. CONCLUSIONS The system is apparently safe, and at least as efficient as other existing means for preventing sores. In addition, it may allow for increased intervals between bed positionings. We conclude that this approach of pressure control has the potential to improve bed sore prevention in a rehabilitation hospital setting.
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Affiliation(s)
- A Catz
- Loewenstein Rehabilitation Hospital, Raanana and Sackler Faculty of Medicine, Tel Aviv University, Israel
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Catz A, Luttwak Z, Agranov E, Ronen J, Shpaser R, Paz A, Lask D, Tamir A, Mukamel E. The Role of External Sphincterotomy for Patients With a Spinal Cord Lesion. J Urol 1998. [DOI: 10.1016/s0022-5347(01)62866-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A. Catz
- Department of Spinal Rehabilitation, Loewenstein Hospital, Raanana and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Department of Urology, Rabin Medical Center, Hasharon-Golda Campus, Petah-Tivka and Department of Community Medicine and Epidemiology, Faculty of Medicine, Technion, Haifa, Israel
| | - Z.P. Luttwak
- Department of Spinal Rehabilitation, Loewenstein Hospital, Raanana and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Department of Urology, Rabin Medical Center, Hasharon-Golda Campus, Petah-Tivka and Department of Community Medicine and Epidemiology, Faculty of Medicine, Technion, Haifa, Israel
| | - E. Agranov
- Department of Spinal Rehabilitation, Loewenstein Hospital, Raanana and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Department of Urology, Rabin Medical Center, Hasharon-Golda Campus, Petah-Tivka and Department of Community Medicine and Epidemiology, Faculty of Medicine, Technion, Haifa, Israel
| | - J. Ronen
- Department of Spinal Rehabilitation, Loewenstein Hospital, Raanana and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Department of Urology, Rabin Medical Center, Hasharon-Golda Campus, Petah-Tivka and Department of Community Medicine and Epidemiology, Faculty of Medicine, Technion, Haifa, Israel
| | - R. Shpaser
- Department of Spinal Rehabilitation, Loewenstein Hospital, Raanana and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Department of Urology, Rabin Medical Center, Hasharon-Golda Campus, Petah-Tivka and Department of Community Medicine and Epidemiology, Faculty of Medicine, Technion, Haifa, Israel
| | - A. Paz
- Department of Spinal Rehabilitation, Loewenstein Hospital, Raanana and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Department of Urology, Rabin Medical Center, Hasharon-Golda Campus, Petah-Tivka and Department of Community Medicine and Epidemiology, Faculty of Medicine, Technion, Haifa, Israel
| | - D. Lask
- Department of Spinal Rehabilitation, Loewenstein Hospital, Raanana and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Department of Urology, Rabin Medical Center, Hasharon-Golda Campus, Petah-Tivka and Department of Community Medicine and Epidemiology, Faculty of Medicine, Technion, Haifa, Israel
| | - A. Tamir
- Department of Spinal Rehabilitation, Loewenstein Hospital, Raanana and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Department of Urology, Rabin Medical Center, Hasharon-Golda Campus, Petah-Tivka and Department of Community Medicine and Epidemiology, Faculty of Medicine, Technion, Haifa, Israel
| | - E. Mukamel
- Department of Spinal Rehabilitation, Loewenstein Hospital, Raanana and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Department of Urology, Rabin Medical Center, Hasharon-Golda Campus, Petah-Tivka and Department of Community Medicine and Epidemiology, Faculty of Medicine, Technion, Haifa, Israel
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Velan GJ, Catz A. [Functional restoration of disability from chronic low back pain rehabilitation: medical approach]. Harefuah 1998; 134:385-9. [PMID: 10909558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Catz A, Itzkovich M, Agranov E, Ring H, Tamir A. SCIM--spinal cord independence measure: a new disability scale for patients with spinal cord lesions. Spinal Cord 1997; 35:850-6. [PMID: 9429264 DOI: 10.1038/sj.sc.3100504] [Citation(s) in RCA: 316] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Spinal Cord Independence Measure (SCIM) is a new disability scale developed specifically for patients with spinal cord lesions in order to make the functional assessments of patients with paraplegia or tetraplegia more sensitive to changes. The SCIM includes the following areas of function: self-care (subscore (0-20), respiration and sphincter management (0-40) and mobility (0-40). Each area is scored according to its proportional weight in these patients' general activity. The final score ranges from 0 to 100. This study was performed to evaluate the reliability of the SCIM and its sensitivity to functional changes in spinal cord lesion patients compared with the Functional Independence Measure (FIM). Thirty patients were included. Scores were recorded one week after admission and thereafter every month during hospitalization. Each area of function was assessed by a pair of staff members from the relevant discipline. The comparison of scores between each pair of rates revealed a remarkable consistency (r = 0.91-0.99; P < 0.0001; slope approximately 1; constant approximately 0). The total SCIM score (mean = 51, SD = 21) was lower than the total FIM score (mean = 87, SD = 23) owing to the difference in scale range structure and the relatively high cognitive scores of our patients; however, a relationship was noted between the scores of both scales (r = 0.85, P < 0.01). The SCIM was more sensitive than the FIM to changes in function of spinal cord lesion patients: the SCIM detected all the functional changes detected by the FIM total scoring, but the FIM missed 26% of the changes detected by the SCIM total scoring. The mean difference between consecutive scores was higher for the SCIM (P < 0.01). We conclude that the SCIM is a reliable disability scale and is more sensitive to changes in function in spinal cord lesion patients than the FIM. The SCIM when administered by a multidisciplinary team, may be a useful instrument for assessing changes in everyday performance in patients with spinal cord lesion.
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Affiliation(s)
- A Catz
- Loewenstein Rehabilitation Hospital, Raanana, Israel
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Catz A, Luttwak ZP, Agranov E, Ronen J, Shpaser R, Paz A, Lask D, Tamir A, Mukamel E. The role of external sphincterotomy for patients with a spinal cord lesion. Spinal Cord 1997; 35:48-52. [PMID: 9025221 DOI: 10.1038/sj.sc.3100349] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
For the last three decades external sphincterotomy has been well accepted as a treatment for bladder outlet obstruction in patients with a spinal cord lesions. Recently, however, its value has been brought into question. To assess the current place of this procedure in the treatment of the neuropathic bladder of spinal origin, we studied the outcomes of sphincterotomy in 32 patients. Post-voiding residual urine volume decreased after surgery in 27 patients (84%), considerably in 22 (69%) of them. Clinical infection resolved in 14 out of 19 patients (74%), hydronephrosis disappeared in two out of three (66%), and vesicourethral reflux improved in three out of five (60%) and was cured in two (40%). Six of the patients (19%) were freed from catheterization, but two patients (6%) lost partial continence. Sphincterotomy is an important tool in the treatment of spinal patients with bladder outlet obstruction and should be considered when the proper indications exist.
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Affiliation(s)
- A Catz
- Department of Spinal Rehabilitation, Loewenstein Hospital, Raanana, Israel
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Abstract
Saccadic characteristics were examined in 15 patients with unilateral hemispheric stroke. Eye movements were measured by a standard electro-oculogram technique. In patients with cortical infarcts, mean gain values were lower than in the control subjects for eye movements directed away from the infarct (contralateral), but higher for eye movements towards the infarct (ipsilateral) (p < 0.025). We suggest that impairment of efferent neural signals from the affected hemisphere of stroke patients may decrease excitation of the contralateral neural circuits and inhibition of the ipsilateral neural circuits of the brainstem saccade generator.
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Affiliation(s)
- A Catz
- Loewenstein Hospital, Raanana, Israel
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Catz A, Ron S, Solzi P, Korczyn AD. The vestibulo-ocular reflex and dysequilibrium after hemispheric stroke. Am J Phys Med Rehabil 1994; 73:36-9. [PMID: 8305179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Patients with hemispheric lesions frequently suffer from equilibrium impairment that may be prolonged and may interfere with rehabilitation. In an effort to clarify whether this phenomenon is related to vestibular dysfunction, we examined the relationship of the horizontal vestibulo-ocular reflex (VOR) with stability in 15 patients with unilateral hemispheric stroke. The study included electro-oculographic recording of the VOR while the patients were rotated in a vestibular chair. Stability was scored in accordance with the patients' ability to maintain equilibrium in six graded positions. The findings demonstrated relationship between VOR gain (eye/head displacement) and equilibrium. It is suggested that the "loss of balance" after stroke may be related to an impairment of the corticovestibular modulation of the vestibular function.
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Affiliation(s)
- A Catz
- Loewenstein Rehabilitation Hospital, Raanana, Israel
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Catz A, Ron S, Solzi P, Korczyn AD. Vestibulo-ocular reflex suppression following hemispheric stroke. Scand J Rehabil Med 1993; 25:149-52. [PMID: 8122080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study examined vestibular function following hemispheric ischemic strokes, by testing the suppression of the vestibulo-ocular reflex (VOR). Fifteen patients with cortical or subcortical infarcts several months after a unilateral hemispheric stroke were compared with control subjects. The results indicated impairment of VOR suppression in patients with cortical infarcts. It is suggested that cortical infarcts may induce a mild and symmetrical impairment of vestibular activity which may be responsible for mild and transient imbalance in patients who undergo stroke.
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Affiliation(s)
- A Catz
- Loewenstein Rehabilitation Hospital, Raanana, Israel
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Catz A, Appel I, Reider-Grosswasser I, Grosswasser Z, Mendelson L, Gepstein R. Late-onset papilledema following spinal injury. Case report. Paraplegia 1993; 31:131-5. [PMID: 8446459 DOI: 10.1038/sc.1993.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Papilledema, is a known complication of various spinal pathologies. It has, however, been only infrequently reported following spinal injury, and may be overlooked in these cases. Presented herein is a 27 year old male who suffered thoracic and lumbar spinal injuries. Papilledema following mild increase in intracranial pressure (IICP) developed 3 weeks following trauma, and subsided within 8 weeks. The importance of routine repeat ophthalmoscopic examinations following spinal injury to detect changes characteristic of IICP is emphasized.
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Affiliation(s)
- A Catz
- Spinal Injury Department Loewenstein Rehabilitation Hospital, Ra'anana, Israel
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Abstract
A new device for elbow extension, developed as a dynamic orthosis and also as a static splint for a C5 tetraplegic arm, is presented. A patient with tetraplegia, probably related to infection of the central and peripheral nervous system, had a paralysed right triceps muscle, with a very strong corresponding biceps. Extension by force of a posterior stretched rubber ring made the arm useful, while the possibility to lock the elbow hinges of the orthosis at any desired angle enabled static splinting of the elbow to increase the range of motion.
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Affiliation(s)
- M Itzkovich
- Loewenstein Rehabilitation Hospital, Raanana, Israel
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