Level Of Neurological Lesion Research Articles

Robotic upright stand trainer (RobUST) and postural control in individuals with spinal cord injury

Context/objective: Assessed feasibility and potential effectiveness of using a novel robotic upright stand trainer (RobUST) to deliver postural perturbations or provide assistance-as-needed at the trunk while individuals with spinal cord injury (SCI) performed stable standing and self-initiated trunk movements. These tasks were assessed with research participants’ hands on handlebars for self-balance assistance (hands on) and with hands off (free hands). Design: Proof of concept study. Participants: Four individuals with motor complete (n = 3) or incomplete (n = 1) SCI who were not able to achieve independent standing and presented a neurological lesion level ranging from cervical 4 to thoracic 2. Outcome measures: Ground reaction forces, trunk displacement, and electromyography activity of trunk and lower limb muscles. Results: Research participants received continuous pelvic assistance via RobUST, and manual trainer assistance at the knees to maintain standing. Participants were able to attempt all tasks. Free hands trunk perturbations resulted in greater load bearing-related sensory information (73% ipsilateral vertical loading), trunk displacement (57%), and muscle activation compared to hands on. Similarly, free hands stable standing with RobUST assistance-as-needed resulted in 8.5% larger bodyweight bearing, 112% larger trunk movement velocity, and higher trunk muscles activation compared to standing with hands on. Self-initiated trunk movements controlled by hands on showed 116% greater trunk displacement, 10% greater vertical ground reaction force, and greater ankle muscle activation compared to free hands. Conclusion: RobUST established a safe and challenging standing environment for individuals with SCI and has the potential to improve training paradigms and assessments of standing postural control.

Prevalence of Sleep Disordered Breathing in Children With Myelomeningocele.

Retrospective studies have shown high rates of sleep disordered breathing in children with myelomeningocele. However, most patients included in those studies underwent polysomnography because of symptoms, so the prevalence of sleep disordered breathing in this population is unknown. To determine the prevalence of sleep disordered breathing in children with myelomeningocele using screening polysomnography. In this cross-sectional study, all children with myelomeningocele seen in a multi-disciplinary spina bifida clinic between 2016 and 2020 were referred for polysomnography regardless of clinical symptoms. Included children had not previously undergone polysomnography. The primary outcome for this study was presence of sleep disordered breathing, defined as Apnea-Hypopnea Index (AHI, number of apnea or hypopnea events per hour of sleep) greater than 2.5. Clinical and demographic variables relevant to myelomeningocele were also prospectively collected and tested for association with presence of sleep apnea. A total of 117 participants underwent polysomnography (age 1 mo to 21 yr, 49% male). The majority were white, non-Hispanic. Median AHI was 1.9 (interquartile range 0.6-4.2). A total of 49 children had AHI 2.5 or greater, yielding a sleep disordered breathing prevalence of 42% (95% CI 33%-51%). In multivariable logistic regression analysis, children with more rostral neurological lesion levels had higher odds of sleep disordered breathing (OR for thoracic, mid-lumbar, and low-lumbar: 7.34, 3.70, 4.04, respectively, compared to sacral level, P=.043). Over 40% of a sample of children with myelomeningocele, who underwent screening polysomnography, had significant sleep disordered breathing. Routine screening polysomnography may be indicated in this population.

Assistive powered exoskeleton for complete spinal cord injury: correlations between walking ability and exoskeleton control.

Wearable powered robotic exoskeletons allow patients with complete spinal cord injury (SCI) to practice over-ground real-world gait scenarios. The global functional interaction subject-exoskeleton is a key factor to produce interlimb coordinated movements. Efficacy and efficiency of over-ground walking abilities using powered exoskeletons are related not only to the symbiotic sensory-motor interaction subject-exoskeleton but also to exoskeleton control. Assess if walking ability of motor complete SCI patients at thoracic or lower level, using a wearable powered exoskeleton (ReWalk), can be influenced by different exoskeleton software control. Observational study; an open, non-comparative, non-randomized study. A single neurological rehabilitation center for inpatients and outpatients. Fifteen SCI chronic patients (4 females and 11 males) were recruited and divided in two groups: group 1, trained with the first software generation of ReWalk, and group 2, trained with the second software generation, a software upgrade of the previous version. Subjects were trained during three 60-minute sessions a week, during at least eight weeks using ReWalk, a wearable lower limb powered exoskeleton that allows thoracic or lower level motor-complete individuals with SCI to walk, stand, sit and climb/descend stairs. Outcome measures, collected at the end of the training period wearing the exoskeleton, were: 6-min Walking Test, 10-m Walking Test, and the time necessary to pass from sitting to standing and start to walk (STS-time). For each group Pearson Coefficient was calculated to explore correlations between the subjects' characteristics and gait performance reached at the end of the training period. Group 1 showed correlation between performances and weight, height, neurological lesion level, while group 2 showed no correlation between performances weight and height, but correlation only with neurological lesion level. Group 2 covered more distance in 6 min (+124.52%) and required less time (-70.34%) to perform 10 mtWT and to STS-time (-38.25%) if compared to group 1. ReWalk allows chronic complete spinal cord injury patients to perform over-ground walking. Different exoskeleton software control of the smoothness of the gait pattern improves functional outcome, eliminating the relationship between anthropometric factors and gait performances. The smoothness of the kinematic control of the lower limbs of the exoskeleton is a key factor to facilitate human-robot interaction and to increase walking abilities of the subject. To underline how the kinematic control of the exoskeleton influences the walking abilities of the complex system subject-exoskeleton.

Ultrasound functional evaluation of fetuses with myelomeningocele: study of the interpretation of results

Objective: To assess the reliability of the interpretation of a new technique for the ultrasound evaluation of the level of neurological lesion in fetuses with myelomeningocele.Methods: Observational study including myelomeningocele fetuses, referred to our center for the sonographic assessment of the fetal lower-limb movements, made and recorded by an expert in Maternal–fetal medicine and a specialist in Rehabilitation. Two observers, with different levels of expertise and blinded to each other’s results, interpreted each recorded scan two different times. The agreement for the segmental levels assigned between the observers and the gold standard, the inter-observer and intra-observer reproducibility were tested using the weighed Kappa (wκ) index.Results: Twenty-eight scans were recorded and evaluated. The agreement between the observers and the gold standard remained constant for the expert observer (wκ = 0.82) and increased (wκ = 0.66-wκ = 0.72) for the other one. The inter-observer and the intra-observer variability for the expert observer were wκ = 0.72 and wκ = 0.94, respectively.Discussion: The agreement for the prenatal evaluation of the segmental neurological level was excellent, after a short training period, for observers with different degrees of expertise. The interpretation of this technique is reproducible enough and this supports its value for the prediction of postnatal motor function in myelomeningocele fetuses.

Mobility, hydrocephalus and quality of erections in men with spina bifida

Little is known about erectile dysfunction (ED) among men with spina bifida (SB). The goal of this study was to determine quality of erections and possible factors affecting erections in this population. It was hypothesized that men who ambulate and do not have a ventriculoperitoneal shunt (VPS) are more likely to have erections sufficient for intercourse. An online survey was administered over an 18-month period to men aged ≥18 years and with SB. Participants were recruited through local, national and international SB organizations via social media. Exclusion criteria were: poor English proficiency, not completing the questionnaire or missing information regarding erections, VPS or ambulation. Data were collected on demographics, previous surgeries and function. Ambulatory status was classified using the Hoffer classification (Hoffer etal., 1973). Those able to walk at least at home, with or without crutches/braces, were classified as "ambulators." Erections were assessed using a single question from the validated Expanded Prostate Cancer Index Composite questionnaire (e.g. normal: "firm enough for intercourse"). Logistic regression was used for statistical analysis. The median age of 122 participants was 33 years, 53.3% were ambulators and 70.5% had a VPS. Overall, 41.0% reported normal erections. Ambulators were more likely to report normal erections than non-ambulators (63.1% vs 15.8%, P<0.001) (Table). Those with and without a VPS reported similar rates of normal erections (37.9% vs 48.6%, P=0.32). On multivariate analysis, ambulators were more likely to have normal erections (OR ≥8.65, P≤0.001) after correcting for age and VPS status. Age and VPS status were not correlated with normal erections on multivariate analysis (P≥0.32 and P=0.62, respectively). Approximately 59% of men with SB reported ED, with ambulators being far more likely to have normal erections. This suggests that ambulatory status, similar to neurological lesion level, is a confounder of erectile function in the SB population. A limitation of the study was that a single item was used to assess erectile function. Rather than performing a comprehensive analysis of sexual health, the study aimed to gauge the prevalence of normal erections and assess possible risk factors. It did not assess sexual activity, erection duration or ED treatments. However, this is the largest study, to date, on SB and erectile quality with international participants. About 40% of men with SB reported normal erections. Ambulatory status, rather than hydrocephalus, appeared to be the primary factor associated with erectile function. Approximately 2/3 of ambulators and 1/6 of non-ambulators reported normal erections.

Neurogenic lower urinary tract dysfunction: evaluation and management.

The lower urinary tract (LUT) in health is regulated by coordinated multi-level neurological inputs which require an intact central and peripheral nervous system. Lower urinary tract dysfunction is, therefore, a common sequelae of neurological disease and the patterns of bladder storage and voiding dysfunction depend upon the level of neurological lesion. Evaluation includes history taking, bladder diary, urological examination when relevant, ultrasonography and urodynamic testing when indicated. Antimuscarinic agents are the first line treatment for patients with storage dysfunction. Alternative treatments include intradetrusor injection of onabotulinumtoxinA, which has been shown to be of benefit in patients with neurogenic detrusor overactivity (NDO), and neuromodulation. Intermittent catheterization remains the option of choice in patients with significant voiding dysfunction resulting in high post-void residual volumes.

Prenatal ultrasound evaluation of segmental level of neurological lesion in fetuses with myelomeningocele: development of a new technique.

To report our preliminary experience in the use of prenatal ultrasound examination to assess lower-limb movements in fetuses with myelomeningocele. We aimed to determine the accuracy of this method to establish the segmental level of neurological lesion, as this is the best known predictor of the future ability to walk. This was a preliminary, observational study including fetuses with myelomeningocele operated on prenatally. The patterns of movements present and absent in the affected fetuses' lower limbs were evaluated systematically by ultrasound examination. According to the known nerve function associated with each muscle group, the segmental level of neurological lesion was established before birth. The agreement for the segmental levels assigned, between the prenatal ultrasound technique and the classical neurological clinical examination after birth (gold standard), was tested using the weighed kappa (wκ) index. Seventy-one fetuses with myelomeningocele were evaluated at the Hospital Universitari Vall d'Hebron. After counseling, the parents opted for prenatal surgery (26 cases), termination of pregnancy (43 cases) or postnatal repair (two cases). Five patients did not fulfil the inclusion criteria for prenatal surgery and three were excluded after birth. In the 18 fetuses that underwent surgery and were analyzed, the agreement between prenatal and postnatal segmental levels assigned was 91.7% for the right limb (wκ = 0.80) and 88.9% for the left limb (wκ = 0.73). The agreement found between prenatal and postnatal assignment of level of lesion in this preliminary study suggests that neurological sonographic evaluation is feasible before birth. This may provide accurate individualized information about the motor function and future ambulation prognosis of fetuses with myelomeningocele.

Influence of neurological lesion level on heart rate variability and fatigue in adults with spinal cord injury.

Group cohort design. To determine the influence of spinal cord injury (SCI) and neurological level on heart rate variability (HRV) and associations with fatigue. SCI rehabilitation outpatient and community settings in New South Wales, Australia. Participants included 45 adults with SCI living in the community and 44 able-bodied controls. Socio-demographic, neurological injury, psychological, HRV and eye blink variables were assessed. Multivariate analysis of variance and post hoc protected t-tests were used to determine differences in HRV and fatigue as a function of the neurological level. Pearson's correlation analysis was used to determine the relationships between these factors. Participants with SCI had significantly reduced sympathetic activity. Those with tetraplegia had lowered sympathetic activity compared with those with paraplegia and able-bodied controls. Neither were differences in parasympathetic activity found between groups nor were there any significant differences found for the time domain or non-linear domains. Higher levels of fatigue were found in the SCI sample, and participants with tetraplegia had higher fatigue levels compared with those with paraplegia. Fatigued participants were more likely to have altered autonomic function-that is, reduced sympathetic activity. Higher levels of neurological impairment in people with SCI are more likely to result in disordered cardiovascular control involving reduced sympathetic activity, whereas elevated fatigue was found to be associated with increased sympathetic dysfunction. Findings highlight the need to address risks associated with this dysfunction, such as improved HRV and fatigue screening for people with SCI and improved education on cardiovascular risk factors.

Do Overhead Sports Increase Risk for Rotator Cuff Tears in Wheelchair Users?

ObjectiveTo analyze whether frequent overhead-sports activity increases the risk for rotator cuff disease in patients with spinal cord injuries (SCIs) who are wheelchair dependent. DesignCross-sectional study, risk analysis. SettingDepartment of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury. ParticipantsPatients (N=296) with SCI requiring the full-time use of a manual wheelchair were recruited for this study. The total population was divided into 2 groups (sports vs no sports), among them 103 patients playing overhead sports on a regular basis (at least 1–2 times/wk) and 193 patients involved in overhead sports less than once a week or in no sports activity at all. The mean age of the sports group was 49.1 years. The mean duration of wheelchair dependence was 26.5 years. The mean age of the no-sports group was 48 years. The mean duration of wheelchair dependence was 25.2 years. Each individual completed a questionnaire designed to identify overhead-sports activity on a regular basis and was asked about shoulder problems. Magnetic resonance imaging scans of both shoulders were performed in each patient and analyzed in a standardized fashion. InterventionsNone. Main Outcome MeasuresPossible differences in continuous data between patients with and without rotator cuff tear were evaluated. The relative risk of suffering from a rotator cuff tear between patients playing overhead sports and those not playing overhead sports was calculated. ResultsOne hundred three patients played overhead sports regularly and 193 did not. There was no difference between groups regarding age, sex, level of SCI, and duration of wheelchair dependence. The body mass index was significantly lower in the sports group than in the no-sports group (P<.0001). A rotator cuff tear was present in 75.7% of the patients in the sports group and in 36.3% of the patients in the no-sports group (P<.0001). Rotator cuff tears were symptomatic in 92.6% of the patients. The estimated risk increase for the sports group to develop rotator cuff tears was twice as high as for the no-sports group (95% confidence interval, 1.7–2.6; P<.001). Similar results were found for the neurological level of lesion (T2–7/<T7), where the estimated risk was about 2.3 times higher in patients with a high neurological level of lesion (T2–7) than in those with a low neurological level of lesion (<T7) (95% confidence interval, 1.82–3.04; P<.001). ConclusionsOverhead-sports activities have been identified as an additional risk factor, along with age and duration of wheelchair dependence, for developing rotator cuff disease in patients with paraplegia. A high frequency of sports activity shows physiological benefits as well as improves the psychological status and quality of life in patients with SCI. The dilemma is how to increase physical activity to gain physiological and psychological health benefits without further increasing overuse of the upper extremities, particularly the shoulder, in patients with paraplegia. The data from this study may be helpful in elucidating the etiology of rotator cuff tear in athletes with paraplegia and in counseling patients with SCI regarding shoulder and upper extremity activity level and provide support for developing preventive strategies.

Enabling motor control in chronic spinal cord injury: found in translation.

Chronic spinal cord injury affects between 440 and 681 people in every million, depending on country (Bickenbach, 2013), and remains an unmet medical need. While there has been an exponential increase in our molecular and cellular understanding of spinal cord injury over the last three decades, with a considerable number of interventions producing functional neurological recovery in experimental models, not one has been translated into an FDA-approved treatment available in the clinic. Translating neurobiological concepts from basic neuroscience to clinical treatments is one of the toughest challenges and its success depends on a bidirectional dialogue (Curt, 2012). In the current issue of Brain , Susan Harkema and Victor Edgerton scale up the results of an earlier case report (Harkema et al. , 2011) to demonstrate that epidural stimulation, beginning >2 years after spinal cord injury, can restore voluntary movement in a select group of patients (Angeli et al. , 2014). Epidural stimulation (25 or 30 Hz, 1.5–2.5 V) was applied to the index patient from the initial case report and to three additional patients (neurological lesion level C7–T5), via an implanted device at spinal cord level L1-S1 as previously described (Harkema et al. , 2011). Two of the patients had lesions classified as grade A according to the American Spinal Injury Association Impairment Scale (AIS) (sensory and motor complete), while two had lesions classified as AIS B (sensory incomplete). The concept of lumbar stimulation to treat spinal injury is derived from research in the ‘spinal cat’ that revealed the presence of a locomotor centre in the lumbar spinal cord (Grillner et al. , 1969), a discovery that was further advanced in human patients by Milan Dimitrijevic. It was subsequently confirmed that both propriospinal and supraspinal afferents to spinal locomotor centres could facilitate motor output in patients with complete spinal …

Idiopathic and neurogenic detrusor overactivity: do the different patterns have urodynamic characteristics related to gender or neurological condition?

To evaluate the urodynamic characteristics of the two patterns (phasic, P and terminal, T) of detrusor overactivity (DO) according to gender and neurological condition. Urodynamic characteristics of DO were analysed in a population with proven urodynamic DO (127 women and 76 men, respectively with 48 and 43 neurological diseases (encephalic, incomplete medullar lesion or peripheral)). Phasic DO is characterized by phasic waves with or without leakage while terminal DO is defined by a single non-inhibited contraction resulting in incontinence. Parameters analysed for both patterns of DO (among other parameters) included: volume and amplitude of the first non-inhibited detrusor contraction (NIDC#1), and for phasic DO: duration of pressure rise during NIDC#1 and number of NIDC. Phasic DO was observed in younger patients in the whole population whatever the gender (women: 55.9 years vs. 64.7 years, p = 0.0052; men: 57.4 years vs. 67.8 years, p = 0.0038). Volume at NIDC#1 was greater for neurological PDO (significant in women: 185 vs. 125 mL, p = 0.0223). Other parameters were not significantly different whatever the gender. Amplitude of NIDC#1 during PDO was significantly lower than that of NIDC during terminal DO (TDO) in both genders whatever the neurological condition (p < 0.0001). Volume at NIDC#1 in both patterns was dependent on the level of neurological lesion. The main difference between the patterns of DO is that PDO occurs in younger individuals. There is no significant difference between urodynamic characteristics of each pattern whatever gender or neurological status. Further studies will provide additional information on the impact of the level of neurological lesion on the pattern of DO.

Epidemiological features of traumatic spinal cord injury in Anhui Province, China

A retrospective hospital-based study. To describe the epidemiologic features of traumatic spinal cord injury (TSCI) in Anhui Province. Two hospitals within Anhui Province, China. We retrospectively reviewed the hospital records on all patients with TSCI, admitted between 1 January 2007 and 31 December 2010 (n=761). Variables included age, gender, occupation, neurological level, severity of injury, cause and treatment. Seven hundred and sixty-one cases of TSCI were identified. Five hundred and eighty eight were males (77.3%) and 173 were females (22.7%), with a mean age of 45 years (s.d.=13, range from 5 to 87). Fall from height was the leading cause of injury (52.6%), followed by transport (21.2%). The neurological lesion levels were cervical (46.3%), lumbosacral (33.3%) and thoracic (20.4%). Prevention strategies for TSCI should target 30-60 age group, males, farmers and fall from height. The results of this study will serve as a basis for further studies on TSCI. The prevention strategies and treatment should be designed according to the injury features.

Influence of the neurological level of spinal cord injury on cardiovascular outcomes in humans: a meta-analysis

Although motor and sensory deficits following spinal cord injury (SCI) are well known, there are still contrasting reports on how SCI affects baseline cardiovascular (CV) parameters and other autonomic functions. Meta-analysis is performed. To examine the effect of injury level on supine and seated CV function in individuals with SCI. A total of 98 studies representing 1968 individuals were retrieved for analysis. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were abstracted from the studies and compared between four groups according to the neurological lesion level, cervical (C) SCI (C4-C8), high-thoracic (HT) SCI (T1-T6), low-thoracic lumbar (LTL) SCI (below T6) and able-bodied (AB) controls. In the supine position, SBP, DBP and HR were lower in C compared with HT, LTL and AB (all P<0.04). In the seated position, SBP and DBP were significantly lower in C compared with LTL and AB (all P<0.003) and HR was significantly lower in C compared with LTL only (P=0.01). A final finding was that C exhibited a lower resting SBP in the seated compared with the supine position (P<0.001). Individuals with SCI exhibit a lesion-dependent impairment in resting CV function, whereby those with the highest injury had the greatest degree of CV dysfunction. A further finding was that individuals with a C injury exhibited a lower resting SBP in the seated vs supine position. Thus, clinicians and researchers should consider lesion level and body position when measuring and interpreting CV parameters in individuals with SCI.

Changes in Electrical Perception Threshold Within the First 6 Months After Traumatic Spinal Cord Injury

Objective. To assess the reliability of the electrical perception threshold (EPT) in healthy participants and its responsiveness in patients for 6 months after traumatic spinal cord injury (SCI). Methods. The reliability of EPT measures was assessed in 15 healthy volunteers (from C3 to S2). EPT measures were assessed in 37 patients at 1, 3, and 6 months after SCI. EPT was determined in dermatomes at, above, and below the neurological level of lesion. Reliability was quantified with an intraclass correlation coefficient (ICC) and responsiveness with the standardized response mean (SRM). Dermatomes were classified as having normal or pathological sensory perception, based on both light touch (LT) and EPT testing. The percentage of agreement between LT and EPT classifications was determined. Results. The ICCs varied considerably between dermatomes (0.00 ≤ ICC ≤ 0.86). Overall, EPTs changed little within the first 6 months after SCI, resulting in small SRM values. Agreement between classifications according to EPT or LT testing varied from 30% to 100%. The least agreement was observed in the first segment below the lesion. Conclusion. Future studies must note that the reliability of EPT differs between dermatomes in healthy participants. Furthermore, at and below the level of the lesion, spontaneous recovery of sensory perception is poor within the first 6 months after SCI. Based on subgroup analyses, if a translational trial aims to improve sensory perception around the level of the lesion, sensory-incomplete tetraplegic patients could be included. These patients show poor spontaneous recovery, and the EPT may detect subtle changes in perception.

Investigation of cartilage degradation in patients with spinal cord injury by CTX-II

Clinical cross-sectional study. To investigate the cartilage degradation by turnover of C-telopeptide fragments of collagen type-II (CTX-II), a molecule specific for articular cartilage in spinal cord injured patients with respect to clinical functional status. Physical Medicine and Rehabilitation Clinics, hospital settings. In 68 patients with spinal cord injury (SCI) level and severity of lesion, duration of disease, American Spinal Injury Association Impairment Scale (AIS), motor and sensory score, presence of spasticity, functional ambulation score (FAS) and duration of daily ambulation were evaluated. Cartilage degradation was demonstrated by urinary CTX-II (uCTX-II) measured by enzyme-linked immunosorbent assay. T test, analysis of variance and Pearson correlation analysis were used for statistical calculations. uCTX-II level was significantly higher in patients with AIS grade A, non-functional ambulators or in patients who did not ambulate at all (P<0.05). Although AIS grade, lower extremity motor score, FAS score and duration of daily ambulation were found to be correlated (P<0.05) with uCTX-II, duration of disease, level of neurological lesion, presence of spasticity were not. This is the first study providing evidence that cartilage degradation is associated with elevated uCTX-II levels in non-ambulating or non-functional ambulating SCI patients. AIS grade A, FAS zero score and no time for daily ambulation were found to cause significant differences in CTX-II level. It may be important to initiate therapeutic programs as soon as possible after SCI to prevent cartilage atrophy.

Efficacies of papaverine and sildenafil in the treatment of erectile dysfunction in early-stage paraplegic men

The aim of the study was to determine which vasoactive agent was more efficacious for erectile dysfunction (ED), intracavernosal papaverine or oral sildenafil, in paraplegic men within the first year after injury by using a penile color Doppler ultrasound as a quantitative imaging method and to determine the association between responses to these two vasoactive agents and factors such as neurological lesion level and lesion severity. A total of 31 male in-patients with spinal cord injury, aged over 18 years, and with neurological lesions below the T6 level within the first year after injury with ED were included. Visual and auditory sexual stimulus (VASS) on day 1 (group 1), VASS with 25 mg intracavernosal papaverine (group 2) and after a wash-out period of papaverine on day 2, and VASS with 50 mg oral sildenafil on day 5 (group 3) were administered to each patient. Measurements of the peak systolic velocity and end diastolic velocity, which were used as vascular parameters during each procedure type, were taken using penile color Doppler ultrasound. Considering the severity of the lesion and the levels of the neurological lesion, there was a statistically significant difference between the PSV values of the group 1 and the other two groups (P<0.05). There was no statistically significant difference between the peak systolic velocity and end diastolic velocity values of groups 2 and 3 (P>0.05) in terms of both the severity and the levels of the lesion. Efficacies of intracavernosal papaverine hydrochloride or oral sildenafil citrate for ED were similar at all neurological lesion levels and lesion severity in paraplegic men within the first year after spinal cord injury.

Glucose tolerance and physical activity level in people with spinal cord injury

Cross-sectional, observational study. To evaluate the associations of physical activity and neurological lesion level with glucose tolerance in people with spinal cord injury (SCI). New South Wales, Australia. Twenty-five people (5 women, 20 men) with SCI (>6 months post-injury) aged between 18 and 65 years were recruited. Exclusion criteria included known coronary heart disease, stroke or diabetes. Participants underwent an oral glucose tolerance test. Fasting and 2-h plasma glucose concentrations were classified according to the World Health Organization categories of glycemia. Participants also completed the Physical Activity Scale for Individuals with Physical Disabilities and mean MET-hours day(-1) was calculated. Associations with the 2-h plasma glucose concentration were calculated through multiple and stepwise regressions. Participants presented with complete or incomplete tetraplegia (n=11 TETRA) or complete or incomplete paraplegia (n=14 PARA) with neurological lesion levels ranging from C3/4 to T12. Mean 2-h plasma glucose was 7.13+/-2.32 mmol l(-1). Nine participants had disordered glycemia (n=6 TETRA; n=3 PARA) and the remaining participants had normal glucose tolerance. Those participants with normal glucose tolerance participated in more moderate-vigorous and strength exercise and undertook more non-exercise-related mobility than those with disordered glycemia. Physical activity and age, but not lesion level were independent determinants of 2-h plasma glucose concentration (r=0.683, P=0.001), explaining 47% of the variance. Physical activity level is independently associated with glucose tolerance in people with SCI. Non-exercise activity may also be important for maintaining normal glycemia.

Fractures in children and adolescents with spina bifida - experience of a Portuguese tertiary care hospital

Materials and methods We reviewed data of all SB patients, aged 0-18, who have been followed in our SB Nucleus in the last two years. Once the eligible population of patients with SB had been assembled, chart reviews were conducted to abstract data from the health records. After that, each family was contacted, either directly or by telephone call. The parameters examined were: date of birth, sex, level of neurological lesion, type of ambulation, shunted hydrocephalus, shunt revision, syringomyelia, history of prolonged immobilization, the number of fractures and their location, age of occurrence of each fracture and the type of provoking stress. We used MATLAB software (Version 7.1) for all statistical analyses.

Effect of carbohydrate ingestion on exercise performance and carbohydrate metabolism in persons with spinal cord injury

Carbohydrate ingestion during exercise and as a pre-exercise bolus improves exercise performance in able-bodied athletes. Little is known about the potential for carbohydrate ingestion to improve exercise performance in athletes with spinal cord injury (SCI), nor the potential physiological limitations of such a practice resulting from an SCI. Therefore, this study investigated the effects of carbohydrate ingestion on exercise performance in physically active and athletic persons with SCI. Six participants with complete SCI (neurological level of lesion ranging from C(6) to T(7)) and normal glucose tolerance were studied twice during 60 min of arm cranking at 65% of peak oxygen consumption followed by a 20-min time trial with the ingestion of either a carbohydrate drink (CHO trial: 0.5 g CHO kg(-1) body weight in 500 ml) or placebo (PLA trial) applied in a double-blind counter-balanced manner. The participants with tetraplegia had sufficient neurological function to permit voluntary arm-cranking exercise. There was no difference in time-trial performance between CHO and PLA trials (P > 0.05). The results suggest that carbohydrate ingestion in persons with SCI does not improve exercise performance.

Lower urinary tract symptoms following neurological illness may be influenced by multiple factors: Observations from a neurorehabilitation service in a developing country

To evaluate the pattern of lower urinary tract dysfunction (LUTD) in patients with neurological disease in the setting of a rehabilitation service in a developing country, and analyze causes for unexpected lower urinary tract symptoms (LUTS). Patients with neurological disorders and having significant LUTS were prospectively evaluated. Level of neurological lesion was localized by neurological examination and investigations. LUTD was evaluated by symptom analysis, bladder diaries and ultrasonography. Storage symptoms were managed using antimuscarinic medications and voiding dysfunction, when significant, was managed by catheterization and patients were regularly followed up. Patients with symptoms that had not been expected based upon their level of neurological lesion were further evaluated. Fifty patients (mean age 43.5 +/- 18.3 years) were included and according to neurological localization, were categorized into suprapontine (n = 9; 18%), infrapontine/suprasacral (n = 25; 50%) or infrasacral (n = 16; 32%) groups. Incontinence was more common in patients with suprapontine and infrapontine/suprasacral lesions (n = 20) (P < 0.03), hesitancy more common with infrapontine/suprasacral lesions (n = 20) (P = 0.004) and retention more with infrasacral lesions (n = 13) (P < 0.001). Patients belonging to suprapontine and infrapontine/suprasacral groups more likely showed improvement at follow up (P = 0.008). Fourteen patients (28%) had unexpected LUTS and this was due to urological causes (n = 6) or multiaxial neurological involvement (n = 8). Potentially treatable factors were managed, resulting in symptom relief. LUTS in neurological disease may be at variance with the pattern expected based upon level of neurological lesion. Such patients may require further evaluation and consideration should be given to concomitant urological conditions and multiaxial neurological involvement.