Cervical Cord Injury Patients Research Articles

Effects of glossopharyngeal insufflation on pulmonary function in cervical cord injury patients.

Quasi experimental. To evaluate the effect of glossopharyngeal insufflation on pulmonary function in cervical cord injury. Indian Spinal Injuries Centre, Vasant Kunj, Delhi, India. Thirty-one cervical cord injured (ISNCSCI A and B) subjects received respiratory rehabilitation for 4 weeks, with the experimental group performing glossopharyngeal insufflation along with respiratory rehabilitation. The groups were assessed at baseline and after 4 weeks for pulmonary function test, chest expansion, dyspnea, and chest tightness. Significant differences were observed in IVC, IC, FVC, FEV1, MEF 75%, PEF, tidal volume, chest expansion, dyspnea, and chest tightness (p < 0.05). Glossopharyngeal insufflation is a technique that can be used to improve the respiratory function after cervical cord injury.

Indentation marks, skin temperature and comfort of two cervical collars: A single-blinded randomized controlled trial in healthy volunteers

BackgroundCollar-related pressure ulcers (CRPU) are a problem in trauma patients with a suspicion of cervical cord injury patients. Indentation marks (IM), skin temperature (Tsk) and comfort could play a role in the development of CRPU. Two comparable cervical collars are the Stifneck® and Philadelphia®. However, the differences between them remain unclear. AimTo determine and compare occurrence and severity of IM, Tsk and comfort of the Stifneck® and Philadelphia® in immobilized healthy adults. MethodsThis single-blinded randomized controlled trial compared two groups of immobilized participants in supine position for 20 min. ResultsAll participants (n = 60) generated IM in at least one location in the observed area. Total occurrence was higher in the Stifneck®-group (n = 95 versus n = 69; p = .002). Tsk increased significantly with 1.0 °C in the Stifneck®-group and 1.3 °C in the Philadelphia®-group (p = .024). Comfort was rated 3 on a scale of 5 (p = .506). ConclusionThe occurrence of IM in both groups was high. In comparison to the Stifneck®, fewer and less severe IM were observed from the Philadelphia®. The Tsk increased significantly with both collars; however, no clinical difference in increase of Tsk between them was found. The results emphasize the need for a better design of cervical collars regarding CRPU.

Study of Decannulation Problems Following Tracheostomy in Quadriplegics

Aim: Decannulation of tracheostomy in cases of traumatic quadriplegia is always a challenge due to respiratory muscle paralysis, chest infections, aspiration and need to care for sacral sores. Aim of this study was to identify and overcome the difficulties in decannulation of tracheostomy in cases of quadriplegia due to cervical spinal cord injury. Material and methods: This prospective observational study was carried out in a tertiary care Spinal Cord Injury Center of a Military Hospital. Ten cases of tracheostomized traumatic quadriplegics were evaluated over 3years. Decannulation was considered once there was normal gag reflex, effective cough, manageable aspiration, oxygen saturation above 90%, no serious pulmonary compromise and no need for bed sores surgery. The cases were followed up for further one year post-decannulation. Results: Eight cases could be decannulated successfully. Only two cases could not be decannulated due to feeble chest movement, ineffective Cough, lack of motivation and occasional aspiration. Conclusion: Cervical cord injury patients have difficult decannulation due to weak respiratory muscles, ineffective cough, aspiration, pulmonary pathology and bed sores. Respiratory muscle exercise, quantified peak cough pressure, assisted coughing, risk benefit approach in aspiration, healing of bed sores and team work are keys to successful decannulation

上肢機能障害者のための回転駆動型ラチェット機構を搭載した力伝達装具の開発

We previously proposeda power assist robot and conductedexperiments for cervical cord injury(CCI) patients. This paper proposed a new type of robot orthosis by making of their residual function around their shoulder in order to operate the wheelchair. A lock/unlock mechanism on the elbow joint is effectively used to transmit the residual function around the shoulder to the hand. We confirmedthat three patients with CCI could use their residual functionaround their shoulderand operate a wheelchair effectively in outdoor environment like high resistance roads and roads with a slope by measuring velocity of the wheelchair and electromyography of his shoulder muscle.

Recovery patterns of spinal cord injury after traumatic cervical cord injury in a developing country

Background: Traumatic cervical cord injury (CCI) management requires extended acute care and lifelong chronic care. Aims: The present study was aimed to find out that after traumatic CCI, if neurological recovery takes place, how early it starts, how long it continues, and after how many weeks we can safely prognosticate that no more recovery will take place. Materials and Methods: Different epidemiological factors, radiological evidence of trauma, types of injury, cause, mechanism of injury, and level were recorded. The patients were examined every week to record any neurological recovery, either as per Frankel's or ASIA grading. These recordings were done till 6 weeks of admission. Cervical fractures were usually treated by continuous skull traction either by Crutchfield tong traction or by head halter traction giving adequate weight according to the level of vertebral fracture. At the end of 2 years, we followed the recovery pattern in 126 CCI patients. Results: 20.00% of patients showed signs of recovery and 56.36% patients did not show any sign of recovery in complete lesion. 69.01% of patients showed sign of recovery and 25.35% patients did not show any sign of recovery in incomplete lesion. 53.84% of patients showed the first sign of neurological recovery within 1 st week, 32.30% in 2 nd week, 9.23% in 3 rd week, and 4.61% in 4 th week. In upper cervical spine lesion, 22.22% of patients showed first sign of neurological recovery within 1 st week, 55.55% in 2 nd week, 16.11% in 3 rd week, and 5.55% in 4 th week. In lower cervical spine lesion, 65.95% of patients showed the first sign of neurological recovery within 1 st week, 23.40% in 2 nd week, 8.51% in 3 rd week, and 2.12% in 4 th week. Conclusions: In traumatic CCI, patients' level of lesion, type of injury, and nature of injury may be helpful in the early prediction of recovery pattern of patients and careful monitoring of these patients may reduce the social burden in developing countries and reduce morbidity and mortality of these patients.

Hyperglycemia During Acute Spinal Cord Injury Is a Detrimental Factor That Impairs Functional Improvement in Acute C3-C4 Cervical Cord Injury Patients Without Any Bony Damages

Spinal cord injury (SCI) is a major public health problem and a devastating event for individuals. Because the central nervous system has a limited capacity for endogenous regeneration and repair, it is necessary to identify factors that exacerbate SCI to prevent any further deterioration of neurological function and improve the outcomes of injuries[1]. We previously demonstrated that transient hyperglycemia during acute SCI is a detrimental factor that impairs functional improvement in mice and human patients after acute SCI[2]. Although we performed not only Pearson x2 analysis but also a multiple linear regression analysis in the previous study, neurological function is difficult to be assessed for the patients with multiple injury levels. It is more ideal to estimate neurological recovery after SCI to match the injury level.

Pneumatically Driven Prehension Orthosis with Force Control Function

A prehension orthosis with a pneumatic actuator has been developed to compensate for the disability of cervical cord injury patients and support their daily activities. One major feature of this orthosis is that the user can continually pinch or hold a target object using a finely adjusted finger force. The movement and force applied to the fingers can be controlled by continuous instructional signals fromthe user through the activity of a command muscle, which is selected from among the muscles without functional impairment in the user’s body. The level of muscle activity can be obtained by using an original sensor that detects the hardness of the target muscle through contact with the skin. The level of muscle activity can be estimated by the hardness information of the muscle. This sensor is easily fixed to a user’s body by using an elastic belt and even works over clothing. Therefore, the user can wear the system very easily. This feature allows the system to be very user friendly. Users can handle fragile objects such as an egg or sculpted-glass by using this prehension orthosis because of its finger force control function. Excellent dexterity in the finger force control has been demonstrated through evaluation tests conducted with various subjects, including a spinal cord injury patient.

Video-urodynamic characteristics and management in complete cervical and thoracic spinal cord injury patients

To explore the video-urodynamic characteristics and management in complete cervical and thoracic spinal cord injury patients. Video-urodynamic examination was performed in 113 patients with complete cervical and thoracic spinal cord injury from January 2008 to May 2010. And their characteristics, managements and 3-year follow-up outcomes were reviewed and analyzed retrospectively. Among them, there were detrusor overactivity (n = 82, 72.57%), detrusor areflexia (n = 31, 27.43%), detrusor external sphincter dyssynergia (n = 71, 62.83%), low-compliance (n = 59, 52.21%), reflux (n = 6, 5.31%) and ultrasonic uronephrosis (n = 12, 10.62%). According to the result of the video-urodynamic examination, detrusor overactivity patients chose oral anticholinergic agents, botulinum toxin type A injection method, detrusor areflexia patients chose regular intermittent catheterization for bladder training. During a 3-year follow-up, there were cystic calculus (n = 2) and urinary infection (n = 7).No special complication occurred. The video-urodynamic characteristics vary in complete cervical and thoracic spinal cord injury patients. The major symptoms include detrusor overactivity, detrusor external sphincter dyssynergia and low-compliance bladder. Proper management is essential for protecting upper urinary tract and preventing urinary system complication.

Epidemiology and Risk Factors of Cervical Spine Injury during Heating Season in the Patients with Cervical Trauma: A Cross-Sectional Study

PurposeThe purpose of this study was to describe the epidemiology of cervical spine injury in the patients with cervical trauma and analyze its associated risk factors during the special heating season in North China.MethodsThis cross-sectional study investigated predictors for cervical spine injury in cervical trauma patients using retrospectively collected data of Hebei Provincial Orthopaedic Hospital from 11/2011 to 02/2012, and 11/2012 to 02/2013. Binary logistic regression analysis was used to determine risk factors for cervical fractures/dislocations or cord injury.ResultsA total of 106 patients were admitted into this study. Of all, 34 patients (32.1%) were treated from 11/2011 to 02/2012 and 72 patients (67.9%) from 11/2012 to 02/2013. The mean age was 41.9±13.3 years old; 85 patients (80.2%) were male and 82 (77.4%) from rural areas. Eighty patients (75.5%) were caused by fall including 45 (42.5%) by severe fall (>2 m). Sixty-five patients (61.3%) of all suffered injuries to other body regions and 32 (30.2%) got head injury. Thirty-one patients (29.2%) sustained cervical cord injury with cervical fractures/dislocations. Twenty-six (83.9%) of cervical cord injury patients were from rural areas and 24 (77.4%) of those resulted from fall including 15 (48.4%) from severe fall (>2 m). Logistic regression displayed that age (OR, 1.47; 95% CI, 1.05–2.07), head injury (OR, 5.63; 95% CI, 2.23–14.26), were risk factors for cervical cord injury and snowing (OR, 8.25; 95% CI, 2.26–30.15) was a risk factor for cervical spine injury due to severe fall (>2 m).ConclusionsThe elder male patients and patients with head trauma are high-risk population for cervical cord injury. As a seasonal factor, snowing during heating season is of note a risk factor for cervical spine injury resulting from severe fall (>2 m) in the patients with cervical trauma in North China.

The Efficacy of Pulmonary Rehabilitation Using a Mechanical In-Exsufflator and Feedback Respiratory Training for Cervical Cord Injury Patients

[Purpose] The purpose of this research was to investigate the effect of pulmonary rehabilitation using a mechanical in-exsufflator and feedback respiratory training on cervical cord injury (SCI) patients. [Subjects and Methods] Thirty-eight patients were selected through a random sampling method and divided into two groups: an experimental group (n=19) and a control group (n=19). The intervention was conducted five times per week over a four-week period. [Results] In the respiratory training group, there were significance improvements in the ratio (%VC) of the predicted value, forced expiratory volume at one second (FEV1), and unassisted peak cough flow (UPCF) after the intervention. [Conclusion] The results suggest that pulmonary rehabilitation using a mechanical in-exsufflator and feedback respiratory training is effective at increasing the lung function, as well as augmenting the strength of cough capacity. This may reduce the respiratory system?related complications of cervical cord injury patients.

2P1-V09 頚髄損傷者の生活支援を目的としたパワーグローブ(福祉ロボティクス・メカトロニクス(4))

2P1-V09 頚髄損傷者の生活支援を目的としたパワーグローブ(福祉ロボティクス・メカトロニクス(4))

2A2-T11 頚髄損傷者の生活支援を目的としたパワーグローブ(福祉ロボティクス・メカトロニクス(3))

2A2-T11 頚髄損傷者の生活支援を目的としたパワーグローブ(福祉ロボティクス・メカトロニクス(3))

(A121) Relation of Dopamine Dependent Hypotension with Outcome in Cervical Spine Injury Patients

BackgroundIt is believed that dopamine resistance sets in within 72–92 hours following therapy. However, in the authors' experience, spinal cord injury patients may require dopamine to maintain blood pressure over several weeks.ObjectivesThis study aims to: (1) assess the incidence and duration of of dopamine dependence in cervical cord injury patients; and (2) find the relation (if any) of dopamine dependent hypotension with outcome of spinal cord injured patients.MethodsThis was a prospective, observational study carried out over 2-month period in the neurosurgery intensive care unit (ICU) at JPN Apex Trauma Centre, AIIMS. All cervical spine injury patients who had hypotension during the hospital stay were included in the study. History, clinical findings, requirement of ionotropic support, management, and outcome were recorded for all enrolled subjects.ResultsDuring the study period 48 patients were admitted with cervical spine injury in the ICU. Of these, 26 patients (54%) had hypotension and were constituted the study group. Eleven patients had complete spinal cord injury (power 0/5) and 15 patients had incomplete spinal cord injury. Twenty-four patients were on ventilator support and two were on oxygen masks. The mean dose of dopamine which the patient receives during the treatment was 7.5 mcg/kg/min with the maximum and minimum doses of 20mcg/kg/min and 2 mcg/kg/min. The mean duration of dopamine support was 17 days (Range 6–48 days). Eight patients (31%) required intermittent dopamine support and 18 patients (70%) required continuous support. The in-hospital mortality was 61% (n = 16). Mortality was significantly lower in patients who received intermittent ionotropic support as compared to those who required continuous ionotropic support (p &lt; 0.01).ConclusionThe patients with spinal cord injury are dependent on dopamine throughout their recovery period. The patients who required intermittent ionotropic support had significant better outcome compared to those who required continuous ionotropic support.

2P2-E03 手指麻痺者用パワーグローブ : 頚椎損傷者の自立的生活と社会参加の支援を目的として(リハビリテーションロボティクス・メカトロニクス)

2P2-E03 手指麻痺者用パワーグローブ : 頚椎損傷者の自立的生活と社会参加の支援を目的として(リハビリテーションロボティクス・メカトロニクス)

Efficacy of topical anesthesia with inhaled aerosolized lidocaine during tracheal intubation under guidance of fiberoptic bronchoscopy in cervical cord injury patients

Objective To evaluate the efficacy of topical anesthesia with inhaled aerosolized lidocaine during tracheal intubation under the guidance of fiberoptic bronchoscopy (FOB) in patients with cervical cord injury complicated with high paraplegia. Methods Sixty-four patients with cervical cord injury complicated with high paraplegia were randomly divided into 2 groups ( n = 32 each): group Ⅰ aerosol inhalation and group Ⅱ spray and cricothyroid membrane puncture. In group Ⅰ aerosolized 2% lidocaine was inhaled. In group Ⅱ after the pharynx and larynx was sprayed with 2% lidocaine, cricothyroid membrane puncture was performed and then 2% lidocaine 2 ml was injected. Midazolam 0.01 mg/kg and fentanyl 1 μg/kg were injected iv in both groups 15 min before tracheal intubation guided by FOB. During tracheal intubation guided by FOB, the intubation condition was assessed, and MAP, HR, ECG and SpO2 were monitored. Results The satisfactory rate of intubation condition and success rate of intubation under the guidance of FOB were significantly higher, and the incidences of arrhythmia and bad memory lower in group Ⅰ than in group Ⅱ ( P ＜ 0.05). Conclusion The topical anesthesia with inhaled aerosolized 2% lidocaine is helpful for improving the FOB-guided tracheal intubation condition, and can reduce the occurrence of adverse effects in patients with cervical cord injury complicated with high paraplegia. Key words: Lidocaine; Administration, inhalation; Anesthesia, intratracheal; Bronchoscopy; Intubafion, intratracheal; Trauma, nervous system; Paraplegia

External Control of Exhalation for Cough Assistance: A Method for Patients With Glottis Dysfunction and/or Tracheostomy

Lee SC, Park JH, Kang S-W, Kim DH, Song SH. External control of exhalation for cough assistance: a method for patients with glottis dysfunction and/or tracheostomy. Objective To investigate the effectiveness of our method of assisting a cough by mimicking the functions of the glottis in patients with bulbar muscle weakness or paralysis and/or those who had a tracheostomy tube. Design Before-after trial. Setting University rehabilitation hospital. Participants Patients (N=35) with bulbar muscle weakness or paralysis and/or those who had a tracheostomy tube. Interventions Not applicable. Main Outcome Measures The unassisted peak cough flow (PCF), the assisted PCF, and the assisted PCF with the external control method mimicking glottis function by an end-inspiratory external closure of the airways. Results Of the 35 patients, 13 were tracheostomized cervical cord injury patients, 11 were neuromuscular disease (NMD) patients with glottis dysfunction only, and 11 were NMD patients with a tracheostomy and glottis dysfunction. Assisted PCF with the external control method were higher than unassisted PCF and/or assisted PCF in all patients. Assisted PCF with the external control methods were measured in all of the patients even when the unassisted PCFs and/or assisted PCFs could not be measured. For patients with measurable assisted PCFs, the assisted PCF with the external control methods were significantly higher than the assisted PCFs. Conclusions We showed the effectiveness of our method of assisting a cough by external control of the glottis in patients with bulbar muscle weakness or paralysis and/or those who had a tracheostomy tube who cannot effectively cough with the help of existing cough assistance methods.

Factors that impede discharge of cervical cord injury patients from emergency hospitals

Factors that impede discharge of cervical cord injury patients from emergency hospitals

当院における頚髄損傷患者の治療経過

We investigated the outcome of cervical cord injury patients treated with conventional rehabilitation in our hospital. For the purpose of this study, we employed FIM score and ASIA motor score as the indices of patient's functional recovery. These indices were expressed as the difference in each score obtained before and after inpatient rehabilitation. Fifty-two cervical cord injury patients were chosen for the subjects (mean age : 47.9, the majority of the patients distributed between teen age and sixty). The main causes of their injury were falling to the ground, downfalling, and traffic accidents. The mean increments of FIM score and ASIA motor score were 14.3 and 3.1 respectively in the completely paralyzed patients. On the other hand, the incompletely paralyzed patients showed 23.4 in FIM score and 12.1 in ASIA motor score, and these were significantly greater than those of the completely paralyzed patients (p<0.05). On the basis of these results, we concluded that conventional rehabilitation may provide functional recovery which facilitates daily living. Contrary to these results, neither complication of cervical fractures nor surgical treatment showed correlation with functional gaining in any of the patients.

The influence of complications on rehabilitation of spinal cord injuries: economical minus effects and physical disadvantages caused by urinary tract infection and decubitus ulcer

There are few studies on the many complications that disrupt the rehabilitation of patients with cervical cord injuries and their subsequent health-economic benefits. I particularly focused on the treatment of urinary tract infection and decubitus ulcers because these are very frequently encountered complications in a clinical setting. I examined how these complications affect the progress of rehabilitation and facilitate a patient's return to society. The subjects included ninety-eight cervical cord injury patients with tetraplegia who were discharged from the Rehabilitation Center for Severely Disabled Persons from 1995 to 2000. I retrospectively investigated these ninety-eight subjects regarding ninety-six items from clinical records, among which twenty items were selected because they are considered to be closely associated with outcome, such as age, sex, length of stay, medical expense, urinary tract infection, and decubitus ulcer. Moreover, I examined the influence that urinary tract infection and decubitus ulcer had on other items. The average length of stay and total medical expenses per patient were 1,174.4 +/- 559.9 days and 13,563,128.4 +/- 6,351,078.1 yen, respectively. Urinary tract infection and decubitus ulcer occurred at a rate of 97% in patients with cervical cord injury undergoing chronic stage rehabilitation, and these complications caused a two-fold prolongation of the length of stay and a three-fold increase in medical expenses compared with patients without complications. It is important to fully recognize that these complications produce many expenses as well as those for the medical treatment of cervical cord injury.

Impact of age on the injury pattern and survival of people with cervical cord injuries.

A retrospective, follow-up study. To differentiate the injury pattern and survival of people with cervical cord injuries with onset at different ages. Rehabilitation wards of a university hospital that is a tertiary referral center in Taipei, Taiwan. The records of acute and traumatic cervical cord injury patients hospitalized from 1989 to 1997 were reviewed. All subjects received comprehensive rehabilitation programs during hospitalization. Their survival status at the end of follow-up was studied. Forty-seven of 109 (43.1%) people with cervical cord injuries were 50 years or older at onset. Older patients were more frequently injured by minor falls, resulting in more incomplete quadriplegia. They also showed fewer spinal fractures, and more demonstrated associated spondylosis and ossification of the posterior longitudinal ligament. Eleven (10.2%) subjects were deceased, found by a linkage to a death registration database at the end of follow-up. The significant predictor of survival status at follow-up was older age at injury using Cox proportional hazards model. Spinal cord injured patients had different injury patterns, demanding different preventative strategies. Those injured at older ages were at higher risk of mortality according to our study. This study was supported in part by grants from the National Taiwan University Hospital (89S2005), Taipei, Taiwan.