Group Of Spinal Cord Injured Patients Research Articles

Does peripheral nerve degeneration affect circulatory responses to head-up tilt in spinal cord-injured individuals?

Despite the loss of centrally mediated sympathetic vasoconstriction, spinal cord-injured (SCI) individuals cope surprisingly well with orthostatic challenges. In the pathophysiology of this intriguing observation spinal sympathetic-, veno-arteriolar-(VAR), and myogenic reflexes seem to play a role. The purpose of this study was to assess whether central (stroke volume, heart rate, blood pressure and total peripheral resistance) and peripheral (leg blood flow, leg vascular resistance and femoral arterial diameter) hemodynamic responses to head-up tilt are different in two groups of SCI patients, i. e., SCI individuals with upper motor neuron lesions (who have spinal reflexes, VAR and myogenic reflexes) (U; n=6) and those with lower motor neuron lesion (who have no spinal reflexes, perhaps no VAR due to nerve degeneration, but intact myogenic reflexes) (L; n=5). Ten healthy male individuals served as controls (C) (normal supraspinal sympathetic control and presence of all reflexes). After 10 min supine rest all individuals were tilted to 30 degrees head-up tilt. Red blood cell velocity (measured by echo Doppler ultrasound) in the femoral artery decreased and vascular resistance increased significantly in all three groups in the upright position compared with supine. Mean arterial pressure (MAP) remained unchanged in U and L and increased significantly in C in the upright versus supine position. The present study shows that all SCI individuals were able to maintain MAP by increasing leg vascular resistance during head-up tilt, despite nerve degeneration in L and lack of centrally mediated sympathetic control in all SCI individuals. Results of the present study suggest that not spinal reflexes but local (myogenic) reflex activity plays a pivotal role in peripheral vascular responses upon head-up tilt when central control mechanisms fail.

Upper Extremity Applications of Functional Neuromuscular Stimulation

Functional electrical stimulation (FES) has been used for increasing muscle strength, decreasing spasticity, and controlling movement of limbs for many years. Most of this work, however, has been done in a research setting. Over the past decade, FES has moved slowly from the laboratory to the clinical world through feasibility studies in groups of patients with spinal cord injuries and strokes. Electrical stimulation has been shown to decrease spastic tone both during and after the stimulation, allowing for better limb positioning, decrease in contracture formation, and in some cases, improvement of voluntary movement. Electrical stimulation as a motor prosthesis is now being provided to small groups of spinal cord-injured patients (primarily C4, C5 and C6 levels) to assist with hand positioning and to produce hand grasp. In these settings, patients have attained greater independence in activities of daily living and in work-related tasks. Distribution of this technology to multiple centers is continuing through a technology transfer program.

Residual Urine Volumes in Patients with Spinal Cord Injury: Measurement with a Portable Ultrasound Instrument

Spinal cord injured (SCI) patients are often placed on an intermittent catheterization (IC) program during their initial rehabilitation in an effort to establish a catheter-free state. A noninvasive method to quantitatively determine residual urine volumes would decrease unnecessary catheterizations and be useful in the management of an IC program. This study was undertaken to determine if bladder volumes could be accurately determined in a group of SCI patients using a portable ultrasound scanner. Fifteen SCI patients underwent a total of 224 ultrasonic bladder volume determinations and 57 urethral catheterizations. Immediately prior to catheterization, two investigators alternately performed a total of four ultrasound readings on each patient using a hand-held portable instrument, the BVI 2000. The first ultrasound volume determination was comparable to the average ultrasound volume (r2 = 0.956). For catheterized volumes versus the initial ultrasound volume determination, r2 = 0.80. The average error was 18% for catheterized volumes within the range 50-700ml. Our results compare favorably with both real-time scanning using standard equipment and other portable instruments. The noninvasive nature, negligible risks, and reasonable estimates of volume warrant consideration of portable ultrasound scanning for the determination of bladder volumes in SCI patients.