Tetraplegia Research Articles

Long-term oral meclozine administration improves survival rate and spinal canal stenosis during postnatal growth in a mouse model of achondroplasia in both sexes.

Achondroplasia (ACH) is a skeletal dysplasia characterized by short-limbed short stature caused by the gain-of-function mutations in the fibroblast growth factor receptor 3 (FGFR3) gene. Activated FGFR3, which is a negative regulator of bone elongation, impairs the growth of long bones and the spinal arch by inhibiting chondrocyte proliferation and differentiation. Most patients with ACH have spinal canal stenosis in addition to short stature. Meclozine has been found to inhibit FGFR3 via drug repurposing. A 10-d treatment with meclozine promoted long-bone growth in a mouse model of ACH (Fgfr3ach mice). This study aimed to evaluate the effects of long-term meclozine administration on promoting bone growth and the spinal canal in Fgfr3ach mice. Meclozine (2mg/kg/d) was orally administered to Fgfr3ach mice for 5 d per wk from the age of 7d to 56d. Meclozine (2mg/kg/d) significantly reduced the rate of death or paralysis and improved the length of the body, cranium, and long bones in male and female Fgfr3ach mice. Micro-computed tomography analysis revealed that meclozine ameliorated kyphotic deformities and trabecular parameters, including BMD, bone volume/tissue volume, trabecular thickness, and trabecular number at distal femur of Fgfr3ach mice in both sexes. Histological analyses revealed that the hypertrophic zone in the growth plate was restored in Fgfr3ach mice following meclozine treatment, suggesting upregulation of endochondral ossification. Skeletal preparations demonstrated that meclozine restored the spinal canal diameter in Fgfr3ach mice in addition to improving the length of each bone. The 2mg/kg/d dose of meclozine reduced the rate of spinal paralysis caused by spinal canal stenosis, maintained the growth plate structure, and recovered the bone quality and growth of axial and appendicular skeletons of Fgfr3ach mice in both sexes. Long-term meclozine administration has the potential to ameliorate spinal paralysis and bone growth in patients with ACH.

The effect of level of injury on diabetes incidence and mortality after spinal cord injury - a longitudinal cohort study.

Retrospective longitudinal cohort study of veterans with SCI. Spinal cord injury (SCI) is associated with an increased risk of developing diabetes mellitus (DM), likely due to body composition alterations and autonomic nervous system dysfunction. These factors are more pronounced in persons with tetraplegia (TP) versus paraplegia (PP). However, the effect of level of injury (LOI) on DM incidence is largely unknown. Therefore, the objective is to examine the effect of LOI on DM incidence in persons with SCI. South Texas Veterans Health Care System. We obtained electronic record data on age, sex, race/ethnicity, LOI and HbA1c concentration from January 1st 2001 through December 31st 2021. Cox proportional hazard regression analyses were used to assess the association between LOI, DM and all-cause mortality. Among 728 non-diabetic veterans with SCI (350 TP/ 378 PP, 52 ± 15 years, 690 male/38 female) 243 developed DM, of which 116 with TP and 127 with PP. Despite chronological variations between TP and PP, DM risk over the entire follow-up did not differ between the groups (hazard ratio (HR): 1.06, 95% CI: 0.82-1.38). Mortality was higher in TP versus PP (HR: 1.40, 95% CI: 1.09-1.78). However, developing DM did not increase the risk of death, regardless of LOI (HR: 1.07, 95% CI: 0.83-1.37). Despite chronological variations between both groups, the level of injury had minimal effect on long-term DM development in this cohort of veterans with SCI. Sponsorship NIH (DK105379; MS), RR&D SPiRE (I21RX003724-01A1; MT and SH).

Wrist extensor pathomechanics: implications for tendon and nerve transfer.

Central and peripheral nervous system lesions may disrupt the intricate balance of the prime movers of the wrist. In spasticity, hyperactive wrist flexors create a flexion moment and, if untreated, can lead to flexion contractures. In patients with C6 spinal cord injury and tetraplegia, the posterior interosseus nerve is typically affected by a complex pattern of upper and/or lower motoneuron lesions causing radial deviation of the wrist due to loss of ulnar deviation actuators. In this report, we illustrate severe pathomechanics that may occur even with relatively modest changes in wrist balance. These results illustrate how thorough understanding of muscle-tendon-joint interaction aids in designing tendon and nerve reconstructive surgeries to normalize wrist positions and balance in neuromuscular conditions.

Chitosan/PEG-mediated spinal cord fusion after complete dorsal transection in rabbits – functional results at 30 days

Background: The aim was to study functional recovery in experimental animals (rabbits) with transected spinal cords treated with a combination of photo-cross-linked chitosan in a homogeneous mixture with polyethylene glycol (PEG-chitosan). Methods: 20 rabbits (n = 10 experimental and n = 10 controls) were submitted to complete spinal cord transection at T9. The experimental group received an intraoperative injection of PEG-chitosan. Neurological recovery was assessed using the modified Basso, Beattie, and Bresnahan scale. Results: In the experimental group, partial recovery of movements, sensory function, and sphincter control were all observed by postoperative day 30. Paraplegia and anesthesia persisted in the control group; 4 controls died versus none in the test group. Conclusion: PEG-chitosan is a candidate for neurological restoration after spinal paralysis.

Expanding the Clinical Spectrum of UBTF-Related Neurodevelopmental Disorder.

UBTF1 gene encodes for Upstream Binding Transcription Factor, an essential protein for RNA metabolism. A recurrent de novo variant (c.628G>A; p.Glu210Lys) has recently been associated with a childhood-onset neurodegenerative disorder characterized by motor and language regression, ataxia, dystonia, and acquired microcephaly. In this study, we report the clinical, metabolic, molecular genetics and neuroimaging findings and histologic, histochemical, and electron microscopy studies in muscle samples of 2 patients from unrelated families with a neurodevelopmental disorder. Data were retrospectively analyzed by medical charts revision. Patient 1, a 16-year-old boy, presented a childhood-onset slowly progressive neurodegenerative disorder mainly affecting language skills, behavior, and motor coordination. Patient 2, a 22-year-old woman, presented with a severe and rapidly progressive disease with dystonic tetra paresis, acquired microcephaly, and severe cognitive deficit complicated by pseudobulbar syndrome characterized by involuntary and uncontrollable outbursts of laughing, dysphagia requiring tube feeding, and nocturnal hypoventilation treated with noninvasive ventilation. Both patients carried the recurrent previously described UBTF1 de novo variant and had signs of mitochondrial dysfunction at muscle biopsy. The metabolic profile of patient 2 also revealed a decrease in CSF biopterin. These case reports add new insights to the UBTF1 disease spectrum instrumental to improving the diagnostic rate in neurodevelopmental disorders.

1276-P: Level of Injury Affects Body Mass Changes but Has No Influence on Alteration in Glycaemic Index in Persons with Spinal Cord Injury—A Prospective Cohort Study

In able-bodied individuals, an increase in body mass index (BMI) enhances the risk of glucose tolerance deterioration and diabetes mellitus (DM). This relationship can be altered after spinal cord injury (SCI) due to muscle atrophy and the potential effects of autonomic dysfunction on glucose metabolism, which are more exaggerated in those with tetraplegia (TP) compared to paraplegia (PP). Here, we investigated the relationship between longitudinal changes in BMI and glycated haemoglobin (HbA1c), as well as the effect of level of injury (LOI) on this relationship, among nondiabetic patients with SCI. In a retrospective cohort of veterans with SCI, electronic data of BMI, LOI, glucose concentration and HbA1c were obtained from Jan 2001 to Dec 2021. A total of 728 patients without DM at baseline were identified (LOI: 350 TP/378 PP, age: 52±15 years, sex: 690 male/38 female), and followed up for a mean of 94 months (TP) and 114 months (PP). At baseline, using the SCI-specific BMI classification (normal weight BMI<22 kg/m2, obesity BMI> 25 kg/m2), 48% of TP and 65% of PP were obese at baseline (BMI TP: 25.6±5.9 kg/m2; PP: 28.0±6.6 kg/m2,; p<0.001). HbA1c at baseline was similar between TP and PP (5.21±0.59% vs 5.27±0.70%, p = 0.175). At the end of follow-up, BMI was increased to a larger extent in PP compared with TP (-0.02±4.11 kg/m2 in TP, +0.55±4.31 kg/m2 in PP; p = 0.05). However, HbA1c changes did not differ between TP versus PP (p = 0.323). The final BMI was associated with baseline BMI (p<0.001) and LOI (p = 0.007), but the last HbA1c value was only associated with baseline HbA1c (p<0.001) and not LOI (p = 0.821) or baseline BMI (p = 0.605). Together, these findings indicate that neither LOI nor BMI appear useful predictors of DM development in persons with SCI. Disclosure S. Hoekstra: None. M.J. Mader: None. M. Trbovich: None. M. Salehi: None.

DEVELOPMENT OF A 2D BIOMECHANICAL MODEL TO SIMULATE SEATED MULTIDIRECTIONAL ARM STRENGTH OF PEOPLE WITH C5-C7 TETRAPLEGIA

AbstractPeople living with tetraplegia experience a significant loss of sensory and motor function; with the severity depending on their injury level and completeness. To complete tasks independently, people with tetraplegia often rely on assistive devices. To avoid upper extremity pain, designs should not require applications of force near the limits of the user's physical strength. This paper establishes a 2D biomechanical model using static equilibrium and joint torque limits to predict multidirectional strength patterns in the sagittal plane for people with C5 to C7 tetraplegia in a seated position. The results from the biomechanical model highlight the areas and directions of high strength. The strength patterns observed in this paper provide an opportunity for designers to evaluate strength requirements and take advantage of areas and directions of high strength and ensure that users are not required to apply force near their physical limit. In doing this, designs such as assistive devices can be developed that enable users with a reduction in strength to operate them independently.

Spinal Meningothelial Meningioma In a Dog

The objective of this study is to report clinical, MRI, surgical and histological findings of spinal meningothelial meningioma in a dog. Study material was a 9 years old, spayed dog with history of progressive non ambulatory tetra paresis. The dog had intact cranial and spinal reflexes, and deep pain perception. Magnetic resonance images revealed a mass located at left side C2-C3 level, hyperintense in T1W, isointense on T2W, well contrast enhancing on postcontrast T1. The mass was microsurgically resected sub gross totally. The dog’s neurological status was improved at one week and survived for 15 months without signs of metastasis. Histological and histochemical workup revealed grade I, meningothelial meningioma. Surgical intervention for spinal meningioma can be suggested as a sole treatment in dogs.

Spinal Nerve Sheath Myxoma

Nerve sheath myxoma (NSM) is a rare myxoid form of schwannoma, which is a benign tumor that usually grows in the same place. They usually arise from small cutaneous nerves in the head, neck, and extremities, but exceptionally, they have also been reported to develop in the spinal canal. Here we describe a case of spinal NSM. The patient was a 4-month-old male who presented with incomplete tetra paresis. Spine magnetic resonance imaging showed a well-demarcated small intradural extramedullary mass at the T10-L1 level. The tumor has typical histological features of myxoid type NSM with myxoid lobules that are separated by fibrous septa or bands of more compact cellular area. Nerve sheath myxomas should be included in the differential diagnosis of spinal canal tumors. Ultrastructural observation of tumor cefis with perineurial, fibroblast-like, and Schwann differentiation suggests an origin from nerve sheath precursor cefis.

Volar versus dorsal approach for supinator to posterior interosseous nerve transfer: An anatomical study in cadavers.

Supinator to posterior interosseous nerve (SPIN) transfer allows reconstruction of finger/thumb extension and thumb abduction for low radial nerve palsy, incomplete C6 tetraplegia, and brachial plexus injury affecting C7-T1. No study has compared dorsal versus volar approach to perform SPIN transfer. This comparison is studied in the present work, assessing supinator motor branch length and ability to achieve nerve transfer from either approach. Ten fresh frozen cadavers were randomly allocated to receive either a dorsal or volar approach to PIN and supinator radial and ulnar branches (RB=radial, UB=ulnar). Supinator head innervation patterns were documented. RB and UB lengths, forearm lengths measured from ulnar styloid to olecranon, visualization of extensor carpi radialis brevis (ECRB) motor nerve without additional dissection, and ability to perform tension-free nerve transfer were assessed. Nine of 10 specimens had supinator branches innervating both heads. The ECRB nerve was visualized in all volar but only one dorsal approach. No significant differences in forearm length were found. Volar with elbow extended: mean RB length was 35±7.8 mm and UB was 37.8±9.3 mm. Dorsal with elbow extended: mean RB length was 30±4.1 mm and UB was 38.8±7.3 mm. Dorsal with elbow flexed 90°: RB was 25.6±3.8 mm and UB was 34.8±4.8 mm. No significant differences were found in branch lengths between approaches (dorsal vs. volar UB, p=.339; dorsal vs. volar RB, p=.117). All limbs achieved tension-free coaptation. Neither approach demonstrated superiority in achieving tension-free nerve transfer. Volar permitted immediate identification of ECRB nerve whereas this was only visualized in one dorsal specimen without additional dissection. Overall, the volar approach allows direct coaptation in elbow extension, mimicking maximal physiologic tension for neurorrhaphy. It simultaneously permits additional procedures for pinch reconstruction via single exposure, circumventing limb/microscope maneuvering, dorsal dissection, and increased operative time. Ultimate choice of approach should depend on surgeon familiarity and potential need for additional simultaneous transfers.

Wheelchair Axle Position Effect on the Propulsion Performance of Persons With C7 Tetraplegia: A Repeated-Measures Study.

To assess the changes in speed, stroke frequency, acceleration, and shoulder range of motion (ROM) associated with different wheelchair axle positions in people with chronic C7 tetraplegia. This repeated-measures study was conducted at the Chronic Spinal Cord Injury Unit, FLENI Escobar, Argentina. The speed, stroke frequency, acceleration, and shoulder ROM during wheelchair propulsion were measured in nine participants with C7 spinal cord injury (SCI) in four different axle positions (forward and up, forward and down, backward and down, backward and up). Two strokes performed at maximum speed were analyzed on a smooth level vinyl floor in a motion analysis laboratory. Data were analyzed for significant statistical differences using the Friedman test and the Wilcoxon signed rank test. Our study showed significant differences in the speed with axle position 1 (1.57 m/s) versus 2 (1.55 m/s) and position 2 (1.55 m/s) versus 4 (1.52 m/s). The shoulder ROM showed a significant difference in the sagittal plane in position 2 (59.34 degrees) versus 3 (61.64 degrees), whereas the stroke frequency and the acceleration parameters showed no statistically significant differences with the different rear axle positions. Our study showed that modifying the rear axle position can improve the propulsion speed and produce changes in the shoulder ROM in the wheelchair propulsion of individuals with C7 SCI.

Omurilik Felçlisi Engellileri Üzerine Dinî ve Manevi Danışmanlık Odaklı Nitel Bir Araştırma

Günümüzde engelli bireyler üzerinde sosyal, psikolojik, medikal ve benzeri alanlarda araştırmalar yapılmakta, onlara kamu, yerel yönetimler ve sivil toplum eliyle birçok hizmet götürülmektedir. Bu alanlar içinde son yıllarda dinî ve manevi danışmanlık hizmeti ihtiyacı özellikle öne çıkmaktadır. Özel nitelikli gruplar üzerinde, ilgili disiplin ve hizmet alanlarında teorik planda ihtiyaç analizi olarak yapılacak nitel araştırmalar, omurilik felçlilerinin dinî ve manevi ihtiyaçlarını tespit etmeye yarayacak ve pratik hizmet alanlarına katkılar sağlayacaktır. Ülkemizde omurilik felçlisi engelliler ve maneviyat üzerinde yapılan nitel araştırmalar oldukça azdır. Bu araştırmada bir aylık süreçte bir haftalık peryotlarla gönüllü katılım sağlayan 15’i kadın, 6’sı erkek, 21 yetişkin omurilik felçlisiyle bir buçuk saatlik odak grup görüşmeleri yapılmış; bulgular, üç ana tema ve sekiz alt tema başlığı altında (Travmatik geçmiş, Anlam arayışı, İnanç, Sosyal İlişkiler, Ritüel ve İbadet, Sosyal Hizmet, Spor, Maneviyat Arayışı) yapılandırılmıştır. Katılımcı grubun dinî ve manevi iyi oluşlarını etkileyen faktörleri, varoluşsal, manevi ve inançsal sorgulama ve arayışlarını, dinî ve manevi iyi oluş için başvurdukları yolları tespit etmek amaçlanmıştır. Bu doğrultuda katılımcılardan 3 ana tema altında gelen 59 cevap ve 222 frekansla, nitelikli bulgulara ulaşılmış; dinî ve manevi olarak iyi oluşlarını etkileyen faktörler, varoluşsal ve inançsal sorgulamalar, dinî ve manevi iyi oluş için başvurdukları yollar tespit edilmiştir. Araştırma sonucunda katılımcıların, dinî ve manevi olarak iyi oluşlarını etkileyen faktörler, varoluşsal ve inançsal sorgulamalar, dinî ve manevi iyi oluş için başvurdukları yollar tespit edilmiştir.

The Emergence of Dry Needling in Stroke Rehabilitation

The management of stroke, acute revascularization and rehabilitation techniques have taken a giant leap in the current decade. The presence of neurological deficits, spasticity and pain are the common limiting factors in post-stroke patients. The various rehabilitation measures in stroke are focused on improving the trio. Spasticity, in a post-stroke patient, is disabling and can be managed using oral pharmacological agents, botulinum toxin, intrathecal baclofen. The use of needle therapy, dry needling, which was commonly used in the management of myofascial pain syndromes has emerged useful in the management of spasticity. Further recent evidence has shown it to be useful in the other dimensions of stroke rehabilitation. Dry Needling is a skilled intervention, that is performed by trained personnel using a filiform needle. It can be performed superficially or deep. The speculative mechanisms by which dry needling reduces spasticity include inducing stretch in the muscle and afferent modulation of the sensory information from the muscle. It improves blood flow and oxygenation, reduces pain through central and peripheral mechanisms. (1)
 The use of dry needling in neurology has evolved from its use in the management of myofascial pain to spasticity in spastic tetra paresis and stroke rehabilitation. In post-stroke patients, dry needling has been used in the management of post-stroke spasticity, balance, post-stroke pain. In the management of spasticity, dry needling using ‘pistoning technique’ in the lower limbs (gastrocnemius, tibialis posterior) and upper limbs (shoulder, elbow and wrist) revealed improved scores in modified modified Ashworth scale (MMAS) that translated to improved gait and range of upper limb motion respectively. The dry needling was performed for 1 minute in each muscle studied. However, the number of sessions varied from a single session to 8-week therapy between studies. In the management of balance, the dry needling of the involved tibialis posterior muscle improved the balance as measured by single-leg stance, balance component of Fugl-Meyer scale and dynamic posturography. The improvement in the above measures is also shown to improve the functional outcome of post-stroke patients in Barthel index, 10-metre walk test, timed up and go test. The dry needling is shown to reduce pain including post-stroke shoulder pain by reducing the pain threshold. The above effects of dry needling were also evident in ultrasound assessment of the intervened gastrocnemius muscle that showed improved muscle length, reduced mean muscle thickness and angle of pennation. (1-3)
 The dry needling has also been studied in post-stroke rehabilitation as a component of the multimodal approach. The use of dry needling in conjunction with electrical stimulation of the muscle is shown to produce persistent improvement in the tone of the muscle. The adverse events noted following the use of dry needling include post interventional muscle soreness, bleeding, bruise and pain during the intervention. Major side effects such as loss of consciousness are rare and hence dry needling serves as a safe therapeutic option in the rehabilitation of post-stroke patients. (1-3)
 Hence dry needling is a safe, cost-effective technique that can be used in the management of post-stroke spasticity, balance, pain that translates to improved functional outcomes. However, further evidence is required to establish the efficacy of this promising technique in the management of post-stroke rehabilitation.

Forefront studies on human T‐cell leukemia virus type 1‐associated myelopathy/tropical spastic paraparesis

AbstractHuman T‐cell leukemia virus type 1 can cause human T‐cell leukemia virus type 1‐associated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T‐cell leukemia/lymphoma in some infected individuals. HAM/TSP is a rare progressive neurological disease characterized by spastic spinal paralysis. The developments in previous research have identified many aspects of the disease pathology. However, the disease is rarely cured, and the aims of treatment remain controlling long‐term progression. This study intends to describe the pathophysiology and treatments for HAM/TSP elucidated from recent studies and the HAM/TSP patient registry.

A Tetra Paresis Revealing Multiple Sclerosis: About a Case and Review of the Literature

A Tetra Paresis Revealing Multiple Sclerosis: About a Case and Review of the Literature

Use of the Physical Abilities and Mobility Scale (PAMS) in Children Receiving Inpatient Rehabilitation for Spinal Cord Related Paralysis

ABSTRACT Objectives: To investigate the performance of the Physical Abilities and Mobility Scale (PAMS) in children receiving inpatient rehabilitation for paralysis related to spinal cord disease and injury (SCD/SCI). Methods: Participants were 146 children with paralysis related to SCD/SCI, aged 2–21, admitted between January 2010 and 2017 for inpatient rehabilitation at a single free-standing academically affiliated pediatric rehabilitation hospital. Retrospective chart review was performed to obtain admission and discharge scores on the PAMS and the functional independence measure for children (WeeFIM®), collected as part of clinical care. Internal consistency was evaluated using Cronbach's alpha. Inter-rater reliability was evaluated through overall agreement, Pearson correlations, and intraclass correlations. Construct validity was examined through exploratory factor analysis. Criterion validity was explored through correlations of PAMS overall and item scores with WeeFIM® total and subscale scores. Sensitivity to change was tested using paired t-tests examining differences between admission and discharge scores for each item and for the total score on the PAMS. Results: Internal consistency and inter-rater reliability were high (0.94 at admission and 0.95 at discharge). Total PAMS scores are highly correlated with total WeeFIM®, mobility, self-care, and cognitive subscores at admission and discharge. Correlations with the WeeFIM® ranged from low (cognitive) to strong (mobility). Total PAMS score and all individual items increased significantly between admission and discharge. Conclusions: The PAMS is a useful measure capturing incremental and granular functional motor skills changes occurring during inpatient rehabilitation for children with spinal cord-related paralysis.

Suboccipital midline approach with C1 laminectomy and C2 partial laminectomy for anterolateral foramen magnum meningioma: A case report

Introduction: Foramen magnum meningiomas (FMMs) arise from meningothelial cells of arachnoid layer in the craniospinal junction. FMMs are rare and comprise only 1.8 to 3.2% of all meningiomas. Patients with FMMs generally have vague symptoms and are often misdiagnosed. Surgical management of FMMs poses a challenge because foramen magnum is a highly complex territory of the skull base and contains many important and vital structures. Up until this date, the surgical approaches for FMMs that arise anterolaterally remain varied. We aimed to present a case of anterolateral FMM that was successfully managed through posterior suboccipital midline approach.Case presentation: A 49-year-old female presented with chief complaint of tetra paresis for the past 4 months. Initially, she was experiencing tingling and numbness on her right neck radiating to her right hand. Her symptoms were worsened, radiating to all of her four extremities along with progressive motor weakness that made her unable to walk. Whole spine MRI was performed and anterior meningioma extending to the right side at the level of foramen magnum was found. The posterior suboccipital midline approach with C1 laminectomy and C2 partial superior laminectomy was performed. The patient made a good recovery immediately after the surgery and there was no recurrence of her symptoms during 4 months follow-up.Conclusion: Surgical approaches for FMM remain varied according to several studies. However, the surgical strategy should be patient-tailored to achieve the maximal resection and prevent morbidity. As for our case, posterior suboccipital midline approach is safe and feasible surgical procedure to treat anterolateral FMM.Keywords: foramen magnum, meningioma, suboccipital midline approach

Consumer Health Information for Spinal Cord Injury and Paralysis

Receiving a diagnosis of spinal cord injury can be devastating for individuals of any age and their family members. For individuals and caregivers, locating current, authoritative information and advice can be overwhelming. Access to this information can help with understanding the condition, identifying available treatments, and improving quality of life.

Tracking and Characterization of Spinal Cord-Injured Patients by Means of RGB-D Sensors.

In physical rehabilitation, motion capture solutions are well-known but not as widespread as they could be. The main limit to their diffusion is not related to cost or usability but to the fact that the data generated when tracking a person must be elaborated according to the specific context and aim. This paper proposes a solution including customized motion capture and data elaboration with the aim of supporting medical personnel in the assessment of spinal cord-injured (SCI) patients using a wheelchair. The configuration of the full-body motion capturing system is based on an asymmetric 3 Microsoft Kinect v2 sensor layout that provides a path of up to 6 m, which is required to properly track the wheelchair. Data elaboration is focused on the automatic recognition of the pushing cycles and on plotting any kinematic parameter that may be interesting in the assessment. Five movements have been considered to evaluate the wheelchair propulsion: the humeral elevation, the horizontal abduction of the humerus, the humeral rotation, the elbow flexion and the trunk extension along the sagittal plane. More than 60 volunteers with a spinal cord injury were enrolled for testing the solution. To evaluate the reliability of the data computed with SCI APPlication (APP) for the pushing cycle analysis, the patients were subdivided in four groups according to the level of the spinal cord injury (i.e., high paraplegia, low paraplegia, C7 tetraplegia and C6 tetraplegia). For each group, the average value and the standard deviation were computed and a comparison with similar acquisitions performed with a high-end solution is shown. The measurements computed by the SCI-APP show a good reliability for analyzing the movements of SCI patients’ propulsion wheelchair.

Six-year follow-up of a survivor of cervical spine fracture and dislocation with oesophageal perforation following long scarf syndrome - a case report and literature review

BackgroundAccidental strangulation due to scarf getting caught in the wheels of a vehicle or machine was called “Isadora Duncan Syndrome” or “Long Scarf Syndrome”. Survival of concomitant fracture dislocation of cervical spine and oesophageal perforation following Long Scarf Syndrome was rarely described and medium-term follow-up for this lesion has not been reported.Case presentationWe present a 39-year-old female who suffered accidental strangulation caused by the scarf around her neck getting trapped in the wheels of the a vehicle and was referred to our hospital forty days post injury. The CT examination showed a fracture dislocation at C5/6 levels with complete dissociation of the supporting structures. She developed paravertebral abscesses, cutaneous fistulas and oesophageal perforation confirmed by oesophagoscope. The patient was treated conservatively because of poor general condition and inappropriate initial treatment. Halo-vest was used to immobilize the cervical spine. The oesophagus-cutaneous fistula was managed with enteral tube feeding and repeated local care. The patient survived despite such severe injury. Nine months after the injury, the oesophageal perforation closed spontaneously and fixed malunion of the cervical spine was achieved. Six-year follow-up demonstrated that the patient survived with complete C5 tetraplegia. Literature associated with this lesion was reviewed and factors contributing to the survival were discussed.ConclusionsConcomitant fracture dislocation of cervical spine and oesophageal perforation following Long Scarf Syndrome is extremely rare with high risk of mortality. Though surgical intervention is always necessary, the optimal management for this kind of lesion should be made on an individual basis through a multidisciplinary approach.