Incomplete Spinal Cord Research Articles

Trans-Spinal Direct Current Stimulation in Spasticity: A Literature Mini-Review

Spasticity is common after a stroke and has a negative impact on functional and quality-of-life measures. There is an unmet medical need to provide safe and effective treatment using non-pharmacological approaches. Trans-spinal direct current stimulation (tsDCS) is an emerging modality for non-invasive neuromodulation that induces reduction of spinal excitability leading to a decrease in spasticity. We describe current treatment options for spasticity, including a literature review about the use of tsDCS in patients with spasticity. We found four clinical studies that used tsDCS to treat spasticity for different neurological conditions including hereditary spastic paraplegia, upper extremity spasticity following stroke, multiple sclerosis, and incomplete chronic spinal cord injury. Spasticity was the primary outcome in three of the studies and a secondary outcome in the final study. The three studies that addressed spasticity as the primary outcome found that active tsDCS decreased spasticity compared to sham. These studies suggest that tsDCS can modulate spinal motor and sensory spinal pathways through the use of specific electrode montages and stimulation parameters. This therapy can improve motor functions and may represent a viable treatment option for spasticity.

수정된 양손집중연습이 불완전 경수 손상 환자의 손 기능과 작업수행에 미치는 영향

Objective: The purpose of this study is to investigate the effect of modified bimanual massed practice training on hand function and occupational performance of a incomplete tetraplegia patient. Methods: The participant was a 27 years old man diagnosed with C7/C7(s), C6/C6(m) incomplete tetraplegia ASIA-C. The patient performed developed modified bimanual massed practice with a total of 20 sessions, 30 minute 5 sessions per each week for 4 weeks modified according to domestic clinical setting. Results: The mean value of dynamometer on the right hand progressively improved through baseline A1(mean 2.96 kg), intervention B(mean 3.07 kg), baseline A2(mean 3.50 kg). And on the left hand, it also increased from B(mean 2.64 kg) to A2(mean 3.04 kg). In the Box and block test, the right hand improved from A1(47 unit) to B(52.55 unit) and maintained for A2, and the left hand improved through A1(46.4 unit), B(47.2 unit), and A2(49.8 unit). And the results of Assessment of Motor and Process skills showed that motor skills improved from before (0.0 logit) to after(0.7 logit), and process skills also improved from 0.7 logit to 1.0 logit. Conclusion: This study results support that the modified bimanual massed practice training is beneficial in improving hand function and occupational performance in a incomplete cervical spinal cord injury patient.

Effects of hyperbaric oxygen therapy on postoperative recovery after incomplete cervical spinal cord injury.

A retrospective study of incomplete cervical spinal cord injury (SCI) treated with and without hyperbaric oxygen (HBO) therapy after operation. To investigate the effects of hyperbaric oxygen therapy on patients' postoperative recovery after incomplete cervical spinal cord injury. Shulan Hangzhou Hospital, Hangzhou, China. We analyzed the clinical data of 78 patients admitted in the Orthopedic Department of our hospital from June 2014 to June 2016, due to trauma-induced incomplete cervical spinal cord injury. All study subjects underwent nerve decompression and internal fixation procedures within 2 weeks of injury. The patients were divided into hyperbaric oxygen therapy (HBO) group (n = 40) and non-hyperbaric oxygen therapy (NHBO) group (n = 38) according to the chosen treatment option. The NHBO group only receive the conventional treatment regimen while the HBO group received a combination of conventional treatment and hyperbaric oxygen therapy. The subsequent changes in spinal functions and activities of daily living (ADL) were assessed by The American Spinal Injury Association (ASIA) scale and the Barthel Index at different time points (pretreatment, 1 month and 3 months of treatment, as well as 6 months, 1 year, 2 years, and 3 years after the surgical procedure). There were no significant differences in age, gender, injury site, and disease condition between patients (p > 0.05). The results showed a significant difference in treatment total effectiveness rate between the HBO and NHBO groups (p < 0.05) (90% and 78.9%, respectively). Analyses of the ASIA scores and Barthel indices between the two groups indicated significant differences at 1 month and 3 months treatment time points, as well as 6 months and 1 year after the initial operation (p < 0.05). It showed that subjects in the HBO group had a better recovery than their NHBO counterparts, with the 1-month treatment time point being the most significant. In addition, the results indicated significant improvements in Barthel Index scores as well as ASIA sensory and motor function scores in both groups after a 1-month treatment, with the HBO group faring significantly better than the NHBO group (p < 0.01). Our results not only showed that hyperbaric oxygen therapy is safe and effective for the treatment of incomplete cervical spinal cord injury but also indicated that the longer the treatment lasts (therapy initiation within 3 months after the surgical operation), the better the effects. In addition, a correct hyperbaric oxygen therapy leads to a peak in recovery within the first postoperative 3 months and can effectively promote spinal cord functions, reduce the disabilities, and improve patients' quality of life.

Effects of Growth Hormone Treatment and Rehabilitation in Incomplete Chronic Traumatic Spinal Cord Injury: Insight from Proteome Analysis.

Despite promising advances in the medical management of spinal cord injury (SCI), there is still no available effective therapy to repair the neurological damage in patients who experience this life-transforming condition. Recently, we performed a phase II/III placebo-controlled randomized trial of safety and efficacy of growth hormone (GH) treatment in incomplete chronic traumatic spinal cord injury. The main findings were that the combined treatment of GH plus rehabilitation treatment is feasible and safe, and that GH but not placebo slightly improves the SCI individual motor score. Moreover, we found that an intensive and long-lasting rehabilitation program per se increases the functional outcome of SCI individuals. To understand the possible mechanisms of the improvement due to GH treatment (motor score) and due to rehabilitation (functional outcome), we used a proteomic approach. Here, we used a multiple proteomic strategy to search for recovery biomarkers in blood plasma with the potential to predict response to somatropin treatment and to delayed intensive rehabilitation. Forty-six patients were recruited and followed for a minimum period of 1 year. Patients were classified into two groups based on their treatment: recombinant somatropin (0.4 mg) or placebo. Both groups received rehabilitation treatment. Our strategy allowed us to perform one of the deepest plasma proteomic analyses thus far, which revealed two proteomic signatures with predictive value: (i) response to recombinant somatropin treatment and (ii) response to rehabilitation. The proteins implicated in these signatures are related to homeostasis, inflammation, and coagulation functions. These findings open novel possibilities to assess and therapeutically manage patients with SCI, which could have a positive impact on their clinical response.

The effects of lower extremity deep sensory impairments on walking capability in patients with incomplete cervical spinal cord injury

Objective: To analyze the impact of lower extremity deep sensory impairment on the walking capability of patients with incomplete cervical spinal cord injury. Design: Retrospective cohort study. Setting: Spinal Injuries Center, Fukuoka, Japan. Participants: Patients with incomplete cervical spinal cord injury who were transferred to the Spinal Injuries Center within 2 weeks of injury and whose progress was monitored for 6 months postinjury were included. Sixty-three patients with a lower extremity motor score of 42 points or more were enrolled. They were divided into lower extremity deep sensory impairment (16 patients) and normal (47 patients) groups, and their walking capability was compared. Interventions: Not applicable. Outcome Measures: Upper and lower extremity motor scores, the presence or absence of deep sensation impairment, and walking capability indices at 6 months postinjury were evaluated. Results: The deep sensory impairment group performed significantly worse than the normal group across items in the Walking Index for Spinal Cord Injury II and in the indoor and outdoor mobility items of the Spinal Cord Independence Measure III. Indoor and outdoor mobility independence levels decreased further in the lower extremity deep sensory impairment group than in the normal group. Conclusions: The presence of lower extremity deep sensation impairments was an important factor affecting the achievement of independent walking capabilities in patients with incomplete cervical spinal cord injury. Hence, when patients with incomplete cervical spinal cord injury undergo walking training, not only their lower extremity muscle strength but also their level of deep sensation impairment must be evaluated.

Complex Restorative Treatment of Patients with Post-Traumatic Tetraparesis

Summary. Despite the rapid development of medical technologies, the problem of restoration the functions of the spinal cord remains unsolved.&#x0D; Objective: to improve the quality of life of patients with the consequences of traumatic damage to the spinal cord.&#x0D; Materials and Methods. The study is based on an analysis of the treatment results of 95 patients with the consequences of traumatic damage to the cervical segments of the spinal cord. Depending on the severity of the spinal cord injury, the patients were distributed as follows: group ASIA A – 43 patients, group B – 37 patients, and group C – 15 patients. Reconstructive surgery was performed on patients from 6 months to 2 years after the injury. Among the methods of rehabilitation treatment, chronic epidural electrical stimulation of the spinal cord (as the first stage of rehabilitation treatment) was used in all patients, neurotization of the anterior interosseous nerve (anterior interosseous nerve AIN) by the branch of the muscular cutaneous nerve – in 38 patients, transposition of the tendon of the deltoid muscle to the tendon of the triceps of the shoulder – in 8 patients.&#x0D; Results. The ASIA impairment scale, SCIM (Spinal cord independence measure scale) and MRC (Medical Research Council scale) were used to evaluate treatment outcomes. The results were evaluated 18 months after reconstructive surgery. In the ASIA A group, the quality of life improved in 74.4% of patients, due to an improvement of the upper extremity function. In the ASIA B group, an improvement in the quality of life was noted in 83.7% of patients, both due to improved self-care and mobility, and due to improved control of the function of the pelvic organs. In the ASIA C group, improved quality of life was mainly due to improved mobility.&#x0D; Conclusions. Complex restorative treatment of patients with incomplete cervical spinal cord injury allowed to improve the quality of life due to correction of segmentary and conductive violations of the spinal cord. In patients with complete spinal cord injury, only segmentary violations are suitable for correction.

The clinical effect and molecular mechanism of transcranial direct current stimulation treatment for incomplete cervical spinal cord injury

Objective To investigate the clinical effect of transcranial direct current stimulation (tDCS) in treating incomplete cervical spinal cord injury, and to explore the possibility of a relationship between the expression of long chain non-coding RNA (LncRNA) and neurological recovery after such injury. Methods Forty-six patients suffering from incomplete cervical spinal cord injury were randomly divided into a tDCS group and a control group, each of 23. The American Spinal Cord Injury Association (ASIA) standard, a functional independence scale (FIM) and the modified Barthel index (MBI) were used to evaluate functional changes before and after 8 weeks of treatment. The neurophysiological evaluations of the spinal cord injury were in terms of somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs). The expression of the LncRNA-MALAT1, MIAT, GPNMB, LILRB4 and SCD1 genes was quantified before and after the intervention. The relationship between the expression of LncRNA and MBI was then further explored. Results The average central motor conduction time (CMCT) of the MEPs and the average central conduction time (CTT) of SEPs in the tDCS group were significantly lower than those before treatment and significantly faster than those of the control group after the treatment. The relative expression levels of LncRNA-MALAT1 and MIAT in the tDCS group were significantly higher than those before treatment and among the control group after the intervention. However, no significant differences were observed in the average expression of the LncRNA-GPNMB, LILRB4 or SCD1 genes. After tDCS the relative expression levels of LncRNA-MALAT1 and MIAT were positively and significantly correlated with MBI scores. Conclusions tDCS can promote the recovery of motor and sensory functions after incomplete cervical spinal cord injury. The underlying mechanism may lie in the up-regulation of LncRNA-MALAT1 and MIAT expression. Key words: Transcranial direct current stimulation; Spinal cord injury; Long chain non-coding RNA

Effects of training with a neuro-mechano stimulator rehabilitation bicycle on functional recovery and paired-reflex depression of the soleus in individuals with incomplete paralysis: a proof-of-principle study

Aim: The present study describes the training effects of a novel motorized bicycle-like device for individuals with incomplete spinal cord injury.Methods: Participants were five individuals with motor incomplete spinal cord injury (56 ± 7 years). Four of five participants received two 30-min sessions of training: one with, and one without, mechanical stimulation on the plantar surface of the foot; soleus paired H-reflex depression was examined before and after each session. Three of five participants received 24 sessions of 30-min of training (long-training). Following the long-training, balance, walking and spasticity improvements were assessed using validated clinical outcome measures, in addition to the H-reflex assessment.Results: One cycling session with mechanical stimulation yielded 14% and 32% more reflex depression in participants with moderate spasticity (n = 2/4). The same trend was not observed in non-spastic participants (n = 2/4). All participants who participated in the long-training had spasticity and showed reduced spasticity, improved walking speed, endurance and balance.Conclusions: Overall, participants with spasticity showed increased soleus H-reflex suppression after one training session with mechanical stimulation and reduced spasticity scores after long training. We interpret this as evidence that the training influenced both presynaptic and postsynaptic inhibitory mechanisms acting on soleus motoneurons. Therefore, this training has the potential to be a non-invasive complementary therapy to reduce spasticity after incomplete spinal cord injury.Trial registration: ClinicalTrials.gov identifier: NCT02554058.

A comparison of urodynamic findings between patients with complete and incomplete traumatic spinal cord injuries

Objective: To compare urodynamic findings between patients with complete and incomplete traumatic spinal cord injuries (SCI) and to determine whether it is important to test with urodynamic study in patients with incomplete SCI. Design: Retrospective study Setting: Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey Participants: A total of 66 patients with 36 complete and 30 incomplete traumatic SCI were included in the study, from July 2012 to September 2014. Interventions: Urodynamic study Outcome Measures: Maximum cystometric capacity (MCC) , vesicle pressure at MCC, detrusor function (detrusor overactivity or not), bladder complience, bladder storage and emptying disorders, post-void residual volume (PVR) and bladder emptying method were recorded. It was also recorded whether the patients used anticholinergic drugs before urodynamic study. Results: In urodynamic findings MCC, vesicle pressure at MCC, PVR, there was no statistically significant difference between complete and incomplete traumatic SCI patients. Also there was no statistically significant difference in low-compliance of detrusor frequency and bladder storage and emptying disorder frequency. Clean intermittent catheterization (CIC) was the most commonly recommended method after urodynamic studies in both groups of patients with SCI. Conclusions: In urodynamic study findings, there was no statistical difference between complete and incomplete traumatic SCI patients. The present study demonstrate that even if patients with incomplete SCI appear to be functionally better than the patients with complete SCI, urodynamic studies should still be performed in patients with incomplete SCI to identify bladder characteristics and to identify appropriate treatment.

Spondylotic traumatic central cord syndrome: a hidden discoligamentous injury?

PurposeTo revisit the concept of spondylotic traumatic central cord syndrome (TCCS) by assessing the frequency of discoligamentous injury and to correlate magnetic resonance imaging (MRI) and intraoperative findings.MethodsA retrospective analysis of twenty-three consecutive patients (mean age: 62.7 ± 14.8 years) with profound spondylotic TCCS after acute cervical hyperextension trauma but without signs of instability on initial CT scans who underwent anterior surgical decompression and fusion was performed. Sensitivity and specificity of MRI in the detection of anterior longitudinal ligament disruption were calculated. The topographic relations between surgically verified segmental instabilities and spinal cord signals on MRI were analyzed. The cervical MRI scans of all patients were evaluated by the radiologist on call at time of admission, re-assessed by a specialized MRI radiologist for the purpose of this study and compared with intraoperative findings.ResultsIntraoperative findings revealed 25 cervical spine segments with hyperextension instability in 22 of 23 (95.7%) patients. The radiologist on call correctly assessed segmental hyperextension instability in 15 of 25 segments (sensitivity: 0.60, specificity: 1.00), while the specialized MRI radiologist was correct in 22 segments (sensitivity: 0.88, specificity: 1.00). In 17 of 23 (73.9%) patients, the level of spinal cord signal on MRI matched the level of surgically verified segmental instability.ConclusionsOur findings challenge the traditional concept of spondylotic TCCS as an incomplete cervical spinal cord injury without discoligamentous injury and emphasize the importance of MRI as well as the radiologist’s level of experience for the assessment of segmental instability in these patients.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.

Early Intervention as an Agent for Recovery of Function After Spinal Cord Injury- A Single Case Study

This case study describes a task-specific training program for working and functional recovery in a young man with incomplete cervical spinal cord injury. The subject was 20 year old male with traumatic spinal cord injury after a fall from height. Prior to intervention, he was quadriplegic with severe motor and sensory impairment. Our goal was to recover the function. The subject underwent disectomy for anterolisthesis of C6 over C7. Acute spinal cord management was started followed by locomotor training, electrical stimulation, orthoses, specialised assistive devices. Outcome measures used were ASIA scale, walking index for SCI, SCIM, Fatigue severity scale, Beck depression scale, SCI-FAI. It was found that specific interventions were intentionally selected in the development of treatment program which helped in the functional recovery of the patient. After 3 and half months treatment, the subject was able to walk with the assistance of AFOs and walker, and was able to perform ADLs independently. The magnitude of his functional improvements could be attributed to early intervention and neuroplasticity.

Functional Outcomes of Patients with Acute Spinal Cord Injury

The purpose of this study was to identify relationships between age, length of stay, the American Spinal Injury Association classification (ASIA) with total functional gain during inpatient rehabilitation for patients with Spinal Cord Injury (SCI) with functional independence and rehabilitation outcomes of traumatic spinal cord patients. The data were obtained for 49 patients with traumatic spinal cord lesions admitted to the neuro physical therapy unit from 2006 to 2008. The mean age was 33 ± 10.63 years. Study design: Retrospective observational study. The patient’s characteristics and outcomes were analysed and compared according to the severity of traumatic spinal cord injuries (SCI) and its appearance according to vertebral level correlations of SCI with co-morbidities was analysed. The Functional Independent measure scores of patient at admission (FIMa) on were compared to Functional Independent Measure scores recorded at discharge (FIMd) to get the total gain for each patient. Patients were grouped according to age, level of neurological injury, length of stay to compare with the total gain. The Length of stay was also compared with the American Spinal Injury Association classification (ASIA) at discharge. The author had been observed that there is negative correlation of LOSa with FIMd and Gain (r=-0.507, p=0.00 and r=-0.402, p=0.004), respectively. FIMa is positively correlated with FIMd but negatively correlated to Gain. FIMd is positively related with Gain. The Mean LOSa and LOSr are 44.80 days and 174.37 days, respectively. The Mean FIMa and FIMd are 53.22% and 75.73%, respectively. It revealed that, a significant improvement in FIM at the time of discharge in SCI patients. The differences were found in the extent of functional improvement between subgroups of patients with different levels and extents of lesions. Regarding the outcome of Functional Independent measure better observed in incomplete cervical spinal cord injuries and complete thoracic spinal cord level injuries. Interestingly, independence in bowel management, independent mobility and locomotion were only attained by patients with incomplete lesions. This study provides insight into the functional outcomes of a group of inpatients with traumatic spinal cord injury. More research is needed to determine the specialized rehabilitation program for these patients.

"Effect of Locomotor Training with Body Weight Support on Gait and Lower Limb Strength in Incomplete Spinal Cord Injury-A Case Report"

Background:&nbsp;Irrespective of the severity of the spinal injury, time after lesion and age at time of injury, the restoration of walking is given high priority by subjects with SCI. There is ample amount of literature with gait training methods for restoration of locomotion from other parts of the world. Rehabilitative training is currently one of the most thriving treatments to promote functional recovery following SCI. Many strategies exist to enhance locomotion, such as treadmill training with and without body weight support, robotic-assisted gait training, functional electrical stimulation, epidural stimulation and surface spinal stimulation. Pertaining to developing countries, this case study is an attempt to determine the effect of Locomotor Training with Body Weight Support on Gait and Muscle Strength in IncompleteSpinal Cord Injury.Methods:&nbsp;Single case design, Body weight support treadmill training for over a period of 12 months for an Individual with SCI (ASIA C) in a private clinic set up for SCI rehabilitation. ASIA lower extremity muscle strength, Spinal Cord Injury Functional Ambulation Inventory and Walking Index for Spinal Cord Injury –II.Results:&nbsp;Significant change in lower extremity muscle strength, gait parameters and temporal parameters of SCI-FAI. Though, no change was observed in score of assistive devices and similarly WISCI-II scoring.Conclusion:&nbsp;Single participant case study provided us with vital evidence for locomotor training with Body weight support in incomplete SCI. Further research in to the field shall yield valuable clinical findings.

Closed-loop afferent electrical stimulation for recovery of hand function in individuals with motor incomplete spinal injury: early clinical results.

Afferent electrical stimulation is known to augment the effect of rehabilitative therapy through use-dependent cortical plasticity. Experiments pairing transcranial magnetic stimulation (TMS) with peripheral nerve stimulation (PNS) have shown a timing-dependent effect on motor evoked potential (MEP) amplitude suggesting that PNS applied in closed-loop (CL) mode could augment this effect through positive reinforcement. We present early results from a clinical trial in which an EEG brain-machine interface (BMI) was used to apply PNS to two subjects in response to motor intent detected from sensorimotor cortex in a cue-driven hand grip task. Both subjects had stable incomplete cervical spinal cord injury (SCI) with impaired upper limb function commensurate with the injury level. Twelve sessions of CL-PNS applied over a 4-6 week period yielded results suggesting improved hand grip strength and increased task-related modulation of the EEG in one hand of both subjects, and increased TMS-measured motor map area in one. These observations suggest that rehabilitation using such interactive therapies could benefit affected individuals.

Usefulness of Coupling Transcutaneous Electrical Nerve Stimulation with Routine Physical Therapy in Spinal Spasticity with Intolerant Drug Sideeffects: A Case Report

Spasticity is a common complaint in patients with spinal cord injury. Clinically, spasticity is characterized by increased muscle tone, exaggerated tendon reflex, frequent muscle spasm and clonus. We report a case of worsening spasticity in a patient with incomplete cervical spinal cord injury (ASIA B) as a consequence to urinary tract infection. The initial baclofen dose of 5 mg/dose three times per day was increased to 15 mg/dose three times/day with dosage increment at 3-day intervals by 15 mg (5 mg/dose). Marked weakness and vertigo was reported. He continued to suffer from severe spasms and trunk tightness that limited his daily activities and induced intolerable pain. The Modified Ashworth Score was increased from 1+ initially to 3, and the Pen Spasm frequency Score deteriorated from initial 1 to 3. After eradication of urinary tract infection with ciprofloxacin, spasticity did not improve, and so was administered with high-frequency transcutaneous electrical nerve stimulation at the parameters of frequency 100 Hz, pulse-width 0.2 millisecond, intensity 15 mA for the duration of 60 minutes for 3 weeks, coupling with routine physical therapy. After 3 week of TENS therapy, final Modified Ashworth Score reduced to 1+ , and Final Penn Spasm frequency Score was decreased to 2 with much improved quality of life. We also discuss the role of coupling transcutaneous electrical nerve stimulation with physical therapy in spinal spasticity.

Combining Adult Learning Theory with Occupational Therapy Intervention for Bladder and Bowel Management after Spinal Cord Injury: A Case Report

ABSTRACTBladder and bowel management is an important goal of rehabilitation for clients with spinal cord injury. Dependence is these areas have been linked to a variety of secondary complications, including decreased quality of life, urinary tract infections and pressure ulcers (Hammell, 2010; Hicken et al, 2001). Occupational therapists have been identified as important members of the health care team in spinal cord injury rehabilitation; however, specific roles and interventions have not been clearly described. This case report will describe occupational therapy interventions embedded with principles of adult learning theory to address bladder and bowel management with an adult client who sustained an incomplete thoracic level spinal cord injury.

The eye movement desensitization and reprocessing approach in pain management – A case report of a patient with paraparesis

Abstract Introduction Somatic symptoms such as pain from psychiatric cause may result from abnormalities in information processing mechanisms in the central nervous system. Bilateral stimulation of the brain by using alternating eye movements assists to unlock and reprocess experiences. Aim The aim of this article is the presentation of the eye movement desensitization and reprocessing (EMDR) method in pain treatment. Case study A 23-year-old patient with paraparesis due to traffic accident three years earlier resulting in incomplete transverse spinal cord damage reported severe pain in paralyzed lower limbs from about one year. Thorough physical and imaging examination had ruled out organic causes of the pain and the patient was diagnosed with psychogenic pain. The standard EMDR protocol was used. In order to determine the mental state of the patient, the following tests were applied: (1) beck depression inventory, (2) the pain disability index, (3) subjective units of distress, and (4) validity of cognition. Therapy was completed when the patient declared resolution of leg pain and returned to rehabilitation. Measurements were performed three times: before treatment, immediately after treatment completion and four months after treatment completion. Results and discussion During a six-week EMDR therapy, the patient achieved a significant improvement. The importance of eye movements in planning rehabilitation strategies in other approach, i.e. modulation of motor control, indicates new research directions of the contemporary comprehensive rehabilitation approach. This study is a single case report, and thus further larger scale studies are required. Conclusions The EMDR method could be helpful in psychogenic pain treatment.

A telephone-based version of the spinal cord injury-secondary conditions scale: a reliability and validity study.

The objective of this study was to determine the inter-rater reliability and validity of using a telephone-based version of the spinal cord injury-secondary conditions scale (SCI-SCS). A psychometric study was conducted. The study was conducted in Royal North Shore Hospital, Sydney, Australia. Forty people with a complete or an incomplete spinal cord injury. Inter-rater reliability was tested by comparing the telephone-based version of the SCI-SCS administered on two different days by two different telephone assessors. Validity was tested by comparing the telephone-based version of the SCI-SCS with the paper-based version of the SCI-SCS. The median (interquartile range) age and time since injury were 54 (48-63) years and 28 (14-35) years, respectively. The intraclass correlation coefficient (95% confidence interval) reflecting the agreement between the telephone-based version of the SCI-SCS administered on two different days by two different assessors was 0.96 (0.93-0.98). The corresponding value reflecting agreement between the telephone-based assessment and the paper-based assessment was 0.90 (0.83-0.95). The telephone-based version of the SCI-SCS is a simple and a quick questionnaire to administer that has both inter-rater reliability and validity. It may be useful as a way to screen for secondary health conditions in low- and middle-income countries where it is not always feasible to provide routine face-to-face follow-ups and where literacy may be a problem.

Management of chronic spinal cord dysfunction.

Both acute and chronic spinal cord disorders present multisystem management problems to the clinician. This article highlights key issues associated with chronic spinal cord dysfunction. Advances in symptomatic management for chronic spinal cord dysfunction include use of botulinum toxin to manage detrusor hyperreflexia, pregabalin for management of neuropathic pain, and intensive locomotor training for improved walking ability in incomplete spinal cord injuries. The care of spinal cord dysfunction has advanced significantly over the past 2 decades. Management and treatment of neurologic and non-neurologic complications of chronic myelopathies ensure that each patient will be able to maximize their functional independence and quality of life.

A Pilot Study on the Effect of Pelvic Exercise on Standing Balance in Patients with Incomplete Cervical Spinal

The purpose of this study was to evaluate the effect of pelvic exercise on standing balance in patients with incomplete cervical spinal cord injury for healthy rehabilitation. 11 patients (8 men and 3 women) with levels of incomplete injury between cervical 3 and cervical 6 who were participated in a study measuring the standing balance using an interactive balance system (IBS) before and after pelvic exercise. The index of standing balance after pelvic exercise was significantly lower than before exercise in patients with incomplete cervical cord injury. The greatest improvements were observed in incomplete cervical spinal cord injury with neurologic levels of cervical 3 and 4 with Brown-Sequard syndrome. These results suggest that the pelvic exercise for rehabilitation significantly improved in part standing balance in patients with incomplete cervical spinal cord injury.