Soft-plastic brace for lower limb fractures in patients with spinal cord injury

STUDY DESIGN

Retrospective study at a rehabilitation center.

OBJECTIVES

Patients with spinal cord injury, even if they are wheelchair users, sometimes suffer from fractures of the lower limb bones. As their bones are too weak to have surgery, and because a precise reduction is not required for restoration, such patients are often indicated for conservative treatment. This case series study investigated the use of a hinged, soft-plastic brace as a conservative approach to treating fractures of the lower extremities of patients with spinal cord injury.

SETTING

National Rehabilitation Center, Japan.

METHODS

Fifteen patients (male, n=10; female, n=5; average age, 52.7 years) with 19 fractures of the femur or the tibia who were treated with a newly-developed hinged, soft-plastic brace were studied. All of them used wheelchairs. We analyzed the time taken for fracture union and for wearing orthotics, degree of malalignment, femorotibial angle and side effects.

RESULTS

The fractures in this series were caused by relatively low-energy impact. The average time taken for fracture union was 80.1 (37-189) days, and the average amount of time spent wearing orthotics was 77.9 (42-197) days. On final X-ray imaging, the average femorotibial angle was 176.9° (s.d. ±8.90), and 15° of misalignment in the sagittal plane occurred in one patient.

CONCLUSION

A hinged, soft-plastic brace is a useful option as a conservative approach for treating fractures of the lower extremities in patients with spinal cord injury.

Contrasting alteration patterns of different cartilage plates in knee articular cartilage after spinal cord injury in rats

STUDY DESIGN

Experimental, controlled trial, animal study.

OBJECTIVE

To assess morphologic changes in different cartilage plates after spinal cord injury and identify the localization of these alterations.

SETTING

Saitama, Japan.

METHODS

A total of 16 Wistar rats were used. Eight rats underwent a spinal cord injury and eight rats had no intervention as control. The cartilage alterations of the knee joint were evaluated with radiography and histomorphometric analysis. To quantify cartilage alterations, we selected the histologic characteristics: thickness of the articular cartilage, number of chondrocytes, matrix staining to toluidine blue as a reflection of proteoglycan content and surface irregularity.

RESULTS

No differences in knee joints were found between the groups by radiography. In the medial knee joint, cartilage thickness of spinal-cord-injured knees increased at the anterior femoral region and decreased at the tibial and posterior femoral regions; however, in the lateral knee, that of spinal cord injuries did not change compared with control knees. Spinal cord injuries decreased the number of chondrocytes, especially at the anterior femoral regions. Matrix staining increased partially at the tibial regions. Surface irregularity of spinal-cord-injured knees was comparable to that of control knees in all cartilage plates.

CONCLUSION

The present findings exhibit characteristics of the cartilage after spinal cord injury. These alterations were different in nature between the medial and lateral regions. Future studies should assess separately different cartilage plates, to overestimate these severities when the changes at the medial knee were examined and to underestimate when the changes at the lateral knee were examined.

Alteration in articular cartilage of rat knee joints after spinal cord injury

OBJECTIVE

Mechanical forces are crucial for the maintenance of the morphologic and functional integrity of articular cartilage. The alteration of the articular cartilage after spinal cord injury (SCI) has been described in relation to a suppression of mechanical forces, since the joint is unloaded and restricted in movement. However, the morphological and biochemical characteristics of the cartilage after SCI are still poorly understood. We identified the localization of cartilage alterations after SCI and verified the influence of mechanical forces on the articular cartilage.

METHOD

A total of 32 Wistar rats were used. Sixteen animals underwent an SCI and 16 animals served as control. The articular cartilage of the knee joint was assessed, respectively, at 4, 8, 10, and 12 weeks after intervention by histochemical, histomorphometric, immunohistochemical, and biochemical analyses.

RESULTS

Cartilage thickness of spinal cord-injured knees decreased at the tibial and posterior femoral (FP) regions and increased at the anterior femoral (FA) region. Spinal cord injuries decreased the number of chondrocytes at the anterior regions and decreased the cartilage matrix staining only at the tibial regions. Immunolabeling to collagen type II was noted comparably in the superficial layer but noted weakly from the middle to deep layer. Collagen type I existed excessively at the cartilage surface and the pericellular regions.

CONCLUSION

Cartilage alterations after SCI would not be explained by only a suppression of mechanical forces by unloading and immobilization, but there may be influences on the cartilage in addition to the change in mechanical forces.

Comparison of muscular and articular factors in the progression of contractures after spinal cord injury in rats

STUDY DESIGN

Experimental, controlled trial.

OBJECTIVES

To identify the relationship between the muscular and articular factors in the progression of contractures after spinal cord injury (SCI).

SETTING

Hiroshima University, Hiroshima, Japan.

METHODS

In total, 48 female Wistar rats were used. The 24 experimental rats that underwent a spinal cord transection and the other 24 control rats that underwent a sham-operation were assessed at 2, 4, 8, 12, 16, or 24 weeks postsurgery. Knee joint motion was measured for flexion and extension. Myotomy of the transarticular muscles was then performed and range of motion was measured again. The degree of contractures was assessed by goniometry measuring the femorotibial angle before and after the myotomies.

RESULTS

The spinal cord-injured rats demonstrated flaccid paralysis during the first few days postsurgery and thereafter spastic paralysis. Intra- and inter-rater reliabilities for all measurements were >0.814. Knee flexion contractures developed in the all experimental rats, and progressed for the first 12 weeks and plateaued thereafter. Both the muscular (48+/-5%) and articular (52+/-5%) factors contributed almost equally to the overall progression of the contracture.

CONCLUSION

The present findings may shed light on the underlying pathophysiology of contractures and should help guide research towards finding the elucidation of contracture development after SCI.

Time-course action analysis of daily life investigations in the Welfare Techno House in Mizusawa

In this study, we have examined the possibility of non-intrusive monitoring at home. We describe the experimental results of the relation between an individual's recorded behavior and the actions detected by the sensors during the course of the subject's daily life. Infrared sensors and the opening of doors and windows and the use of appliances were used. In this paper, it is assumed that the subjects were sleeping when there were no responses by the infrared sensors or when only the bedroom sensor was responding. The sensors were able to detect excretion by using the outputs of the infrared sensor and the water valve of the lavatory, even if a subject did not record it in the time-course of daily life during the investigation. Our findings show that the actions of subjects who stayed at Welfare Techno House (WTH) in Mizusawa could be estimated from outside the house, especially for sleeping and excretion.

The order of reacquirement of activity of daily living functions in people with spinal cord injury during rehabilitation after initial medical treatment and its affecting factors

The purpose of this study was to investigate the order of reacquisition of activity of daily living (ADL) functions during inpatient rehabilitation at our spinal cord injury unit following the individual's initial medical care and to investigate what initial medical and biological factors would affect the ADL functions which the individual with spinal cord injury could perform 14 weeks after the beginning of inpatient rehabilitation. Fifty-two patients with spinal cord injuries who were hospitalized in the rehabilitation unit after their initial medical care participated in this study. The participants' ADL abilities were measured using the Barthel Index every four weeks after hospitalization for a period of 26 weeks. The order of reacquisition of ADL functions included in the Barthel Index was analyzed. Multiple regression analysis was performed to analyze the initial medical and biological factors affecting ADL reacquisition 14 weeks after hospitalization. The order of reacquisition of the ADL functions was almost the same in each individual. The multiple regression equations of the Barthel Index score and number of ADL functions after 14 weeks were both significant and the explanatory variables in both equations included the patients' age, complications on the initial stage and traumatic brain injury as an associated injury with spinal cord injury. We concluded that the patient's score on the Barthel Index and what the patient could actually perform 14 weeks after hospitalization could be predicted from the patient's status at hospitalization in the rehabilitation unit. This predictable correlation can contribute to the rehabilitation management for spinal cord injuries.

Retrospective study of factors affecting employability of individuals with cerebral palsy in Japan

The purpose of this study was to investigate the characteristics of individuals with cerebral palsy that affected their ability to find a job in Japan. A retrospective nonrandomized descriptive study was performed. Subjects were 99 individuals with cerebral palsy who were eligible to have a vocational training at the National Rehabilitation Center for the Disabled after graduation from high school. All of them were able to perform ADL unassistedly. The mean age of the subjects was 19.9 years (range, 18 to 33) and the mean intelligence quotient measured by WAIS-R was 78.5 (range, 46 to 110). Walking ability, being female and experience of learning in a regular middle high school were significant explanatory variables in the multiple regression equation. The ability of individuals with cerebral palsy to get a job in Japan in the 1990's was largely determined by being able to walk and having an education in a regular school.

Cardiorespiratory endurance in people with cerebral palsy measured using an arm ergometer

OBJECTIVE

To determine whether cardiorespiratory endurance, a component of physical fitness, in people with cerebral palsy (CP) is lower than that in able-bodied people, and whether the difference in locomotion of CP patients affects their cardiorespiratory endurance.

DESIGN

Nonrandomized control trial.

SETTING

Referred care center.

SUBJECTS

Twelve men with CP who were independent in daily life and 7 able-bodied control volunteers.

INTERVENTION

Cardiorespiratory endurance of the subjects was measured with an arm ergometer.

MAIN OUTCOME MEASURES

Oxygen consumption (VO2), heart rate (HR), and physical working capacity (PWC) measured during arm ergometer rotation.

RESULTS

The 75%VO2max and 75%HRmax did not differ significantly between CP subjects and control subjects, or between ambulatory CP subjects and wheelchair-bound CP subjects. However, the PWC at 75%HRmax of the CP subjects was significantly lower than that of the control subjects.

CONCLUSION

Cardiorespiratory endurance does not differ significantly between people with CP and able-bodied people. Type of locomotion does not affect cardiorespiratory endurance. However, the highest PWC performed by the CP subjects was significantly lower than that of the control subjects.

Rehabilitation of spinal cord injury in the national rehabilitation center for the disabled of Japan: profile of a spinal service

The National Rehabilitation Center for the Disabled (hereunder abbreviated NRC) in Japan was established in 1979. It consists of four divisions: the hospital, the rehabilitation training center, the research institute, and the information service section. The spinal unit has been functioning and cooperating corelatively with all of these divisions. There were 1047 patients with a spinal cord injury treated in the 15 years from September, 1980 to August, 1994; consisting of 924 males (88.3%), and 123 females (11.7%). The breakdown of causes of injury were traffic accidents 44.9%, having a fall 14.7%, sports accidents 6.7%, and other causes of spinal paralysis 10.5%. The sites of the spinal cord lesions were cervical 372 (35.5%), thoracic 547 (52.5%), and lumbar spinal cord 128 patients (12.3%). The incidence of complete paralysis in those with a cervical spinal cord injury (SCI) was 68.8%, and for thoracic and lumbar SCI 79% each. The time for completion of activities of daily living (ADL) was 12.0 +/- 1.54 months in those with tetraplegia, and 5.6 +/- 1.71 months for those with paraplegia. The rate of employment for reentry into society was 59% in those with a cervical spinal cord injury, and 74% each in those with a thoracic or lumbar spinal cord injury.

A novel method for induction and detection of anaphylactic reaction using the mouse abdominal wall (AW method)

We found that an antigen-specific anaphylaxis was induced by antigen challenge to the abdominal wall, ear auricle, or subcutaneous tissue in mice sensitized 9 days previously with antigen and adjuvant. The anaphylactic reaction was detected by vascular permeability at the injected site 7 minutes after challenge, which was the best time for estimation. A novel method (AW method) for induction and detection of the anaphylactic reaction in mice was established using the abdominal wall as the challenge site. This method could detect the anaphylactic response in mice 1 to 3 weeks after sensitization. The increase in vascular permeability was completely inhibited by administration of diphenhydramine.

A quantitative analysis of cerebrospinal fluid flow in post-traumatic syringomyelia

Cerebrospinal fluid (CSF) flow within the syrinx in post-traumatic syringomyelia was studied by cardiac-triggered phase images of magnetic resonance imaging (MRI) to investigate the relationship between CSF flow in the syrinx and patients' symptoms.

[A quantitative analysis of cerebrospinal fluid flow in posttraumatic syringomyelia]

Cerebrospinal fluid (CSF) flow within the spinal canal and syrinx in posttraumatic syringomyelia were studied by cardiac-gated phase images of magnetic resonance imaging in 12 normal volunteers and 8 patients with syringomyelia. The cardiac-gated phase method was simple and useful for detection of CSF flow; 1) phase modulation was in direct proportion to flow velocity, 2) phase modulation was not affected by the T1 or T2 relaxation time. In normal volunteers, CSF flows caudally during systole and cranially during diastole. The maximum caudal CSF flow velocity at C2 level was from 0.45 cm/sec to 1.71 cm/sec, average; 1.27 cm/sec. All of symptomatic posttraumatic syringomyelia patients had the flow in the syrinx.

[Spinal flexibility and activities of daily living for the thoracic and lumbar spinal cord injured--comparison of a non operated group with an internal spinal fused group]

There has been a great argument in selecting conservative treatment or surgical repair for the spinal cord injury as an early stage treatment. The purpose of medical treatment is to bring a patient back to the society as soon as possible by early intervention and rehabilitation, while preventing complications of the injury. We are faced with a difficulty in determining the superiority between conservative treatment and surgical repair, since no comparative statistical analysis has been available among various rehabilitation methods for the spinal cord injury. We treated 171 patients in the past with traumatic thoracic or lumbar spinal cord injury who were submitted to our hospital for the ADL training purposes. We selected and studied 34 complete paraplegic cases with no complications who started receiving ADL training within 2 months period after the injury from among these cases. (1) Non-ope group was superior in spinal flexibility to internally spinal fused group. (2) Non-ope group reached ADL independence 1.4 months earlier than I.S.F. in case of upper thoracic injury. ADL independence was reached almost at the same time in the lower thoracic injury cases by either treatment. Above all, it is concluded that conservative treatment is more helpful to establish rehabilitation in shorter length of time than surgical repair.