Spinal Cord-injured Population Research Articles

Psychological interventions for chronic pain following spinal cord injury.

Currently, no literature is available regarding the clinical efficacy and treatment outcome of psychological interventions for chronic pain among spinal cord injured (SCI) persons. The present article provides a framework for cognitive-behavioral interventions used with other pain populations and suggested application for the SCI population with chronic pain. Primary focus is upon a biopsychosocial model with patient self-management as the treatment goal. SCI rehabilitation has traditionally relied upon self-management strategies, as have recent psychological treatment approaches for chronic pain. In addition, recommendations for treatment outcome research are provided with the emphasis on using existing standardized assessment and measurement protocols.

ATRIAL FIBRILLATION ASSOCIATED WITH AUTONOMIC DYSREFLEXIA

Autonomic dysreflexia is an acute disorder of autonomic homeostasis occurring in persons with spinal cord lesions above the major splanchnic sympathetic outflow. Atrial fibrillation is a serious cardiac arrhythmia characterized by disorganized atrial depolarization and an irregular ventricular response. Previously reported complications of autonomic dysreflexia have included seizures, strokes and cardiac arrhythmias other than atrial fibrillation. We present a 60-yr-old man with C-5 incomplete quadriplegia in whom atrial fibrillation was apparently induced by an episode of autonomic dysreflexia. Mechanisms by which autonomic dysreflexia may cause this arrhythmia include altered cardiac autonomic tone as well as atrial distention. The simultaneous occurrence of autonomic dysreflexia and atrial fibrillation poses special diagnostic problems and treatment risks. Atrial fibrillation incidence increases with age in the general population. With the aging of the spinal cord-injured population, we expect to see more episodes of atrial fibrillation associated with autonomic dysreflexia.

Cost-effective Screening by Nursing Staff for Urinary Tract Infection in the Spinal Cord Injured Patient

Screening tests for urinary tract infections (UTI) are used in the clinical laboratory setting. This study evaluated the efficacy of screening by nursing staff on the inpatient unit, instead of the clinical laboratory, in the spinal cord-injured population. Fifty-three consecutive traumatically spinal cord-injured patients had weekly urine collection, except when infected or on antibiotics. Each urine sample was tested by a nitrite and leukocyte esterase (LE) dipstick (Chemstrip LN by Bio-Dynamics) and by routine clinical laboratory culture. A total of 169 tests were completed. The correlation coefficients of the LE and the nitrite tests with the culture were 0.604 (P less than 0.001) and 0.663 (P less than 0.001), respectively. The correlation of the combined tests was 0.837 (P less than 0.001). The sensitivity, specificity and positive and negative predictive values of nitrite-LE testing by nursing staff were calculated and compared favorably with published performances of clinical laboratory staff. When measured against the culture, the combined nitrite and LE test had a sensitivity of 79%, specificity of 99% and positive and negative predictive values of 96% and 95%, respectively. The use of a protocol where laboratory culture is performed only when the dipstick test is positive, would reduce the number of cultures by 83%. After extra costs of the additional screen are added, the use of dipstick screening methods by nursing staff can reduce the cost of weekly urine screening by 73%, with a false negative rate of only 4.4%. The expense and complexity of screening for UTI is reduced, response time is minimized and laboratory cultures will have a higher probability of useful clinical information.

Vascular reconstruction for limb salvage in the spinal cord injured patient

Severe arterial insufficiency of the lower extremity secondary to atherosclerosis is manifested in the clinical setting by the development of gangrene and ulcération. Clinicians caring for the spinal cord injured (SCI) patient with a threatened ischaemic extremity have previously advocated primary amputation. At our institution, we have adopted an alternative approach to the clinical problem utilising vascular reconstruction for limb salvage. During the period October 1980 to February 1988, 6 spinal cord injured patients were identified who were treated for limb-threatening ischaemia by vascular reconstruction in lieu of primary amputation. A combined approach of local wound care (debridement) and improvement of the arterial inflow by percutaneous transluminal angioplasty and/or operative vascular reconstruction successfully avoided major amputation in 6 of 7 threatened extremities. Follow-up data was complete in all patients and ranged from 4 to 52 months with an average of 20 months. In the review period, there was no operative mortality with a cumulative limb salvage rate of 86%. The clinician caring for the spinal cord injury patient with an ischaemic limb should: (1) proscribe the patient's use of tobacco products; (2) consider vascular reconstruction in lieu of primary amputation whenever feasible. Limb salvage may be of benefit to the SCI population with improvements in body image, sedentary stability and the activities of daily living.

Posttraumatic syringomyelia: the British Columbia experience.

Posttraumatic syringomyelia is an uncommon late complication of spinal cord injury. This study identified nine patients with posttraumatic syringomyelia and examined initial presentation, neurologic status, ability to perform functional activities, and results of treatment. Pain and numbness were the most common presenting symptoms. Motor impairment occurred later but was more disabling. Functional abilities depended mainly on the level of the original spinal cord injury. Three patients were managed conservatively and have had no significant progression of their neurologic deficit. Six patients were managed with syringoperitoneal or syringosubarachnoid shunts. Pain improved most consistently after surgery. Motor power improved less and sensation least. Ability to perform activities of daily living did not significantly change after surgery. Posttraumatic syringomyelia remains a difficult therapeutic problem in the spinal cord-injured population.

Limited value of the Fairley test in urologic infections in patients with neuropathic bladders.

In an attempt to localize sites of urinary tract infection, a combined Fairley washout test and prostatic localization was performed on 110 spinal cord injured (SCI) patients with neurogenic bladder dysfunction and a history of recurrent bacteriuria. Analysis of 100 patients demonstrated both single and double site of localization. Single sites of localization involved: upper tract 21 of 92 (23%), bladder 15 of 92 (16%), prostate eight of 92 (9%), and 48 of 92 (52%) undetermined. In eight cases, double site of localization was documented: prostate and upper tract six of eight (75%), prostate and bladder one of eight (12%), and prostate and undetermined one of eight (12%). Eighty-seven patients were followed post localization with urine cultures on the fourth or tenth day post procedure; 27 patients (31%) became sterile post localization, 55 patients (63%) stayed infected (greater than or equal to 10(4) colonies/ml), and five patients (6%) had less than 10(4) colonies/ml. Limitation of the Fairley washout may be attributed to the following: difficulty in sterilizing large atonic and trabeculated bladders, TUR sphincterotomy with widely open bladder neck, and heavy urethral colonization from use of external urinary collecting devices. Our modification of Fairley's test included irrigation of the urethra in seven patients. The final bladder irrigant specimen was positive in only one patient compared to 16 of 37 patients without urethral irrigation. We conclude that the ability of the modified Fairley washout and prostatic localization to diagnose the site of urinary tract infection in an SCI population is limited. However, as a mechanical washout for asymptomatic bacteriuria, the Fairley test was found to be beneficial in 31% of the patients as a therapeutic modality.

Sexual response in spinal cord injured adults: a review of the literature.

The literature on sexual response in spinal cord injured (SCI) adults is reviewed and criticized. Principal characteristics of spinal cord injury are reviewed, and variables usually taken into account in studying sexual behavior in the SCI population are specified. Target behaviors of erection, ejaculation, attempts at intercourse, and male and female orgasm are isolated, and relevant data are reported. Attention is given to conceptual and methodological shortcomings of past research. Literature relevant to remediation of sexual problems in the SCI population is reported, and outcomes are noted. Future directions for research are indicated with particular emphasis placed on the appropriate utilization of psychophysiological techniques.

Time-varying cortical activity and connectivity from high resolution EEG. Single subject and simultaneous multi-subject recordings

Event Abstract Back to Event Time-varying cortical activity and connectivity from high resolution EEG. Single subject and simultaneous multi-subject recordings Laura Astolfi1* 1 Imperial College London, United Kingdom Aim: In this paper we present a body of techniques for the analysis of time varying cortical activity and functional connectivity starting from high-resolution EEG recordings. Methods: The proposed methods include the use of realistic head modelling and the linear inverse estimation of the cortical activity in a series of Regions of Interest of the cortex (ROIs). As a connectivity estimator, time-varying Partial Directed Coherence was obtained by the adaptive recursive fit of an MVAR model with time-dependent parameters. We propose two application of these techniques. In the first we estimated time-varying cortical connectivity patterns from a group of Spinal Cord Injured (SCI) patients during the attempt to move a paralyzed limb, with the simultaneous lips protrusion as an external trigger of the self-paced attempt. The second application is about the characterization of the brain responses during social interaction. We present the results of the simultaneous neuroelectric recording (EEG hyperscanning) of 5 couples of subjects engaged in the paradigm called Prisoner's Dilemma, derived from the game theory. Results: For the first experiment, the experimental evidences obtained support the conclusion that the SCI population involved a larger cortical network than those generated by the healthy subjects during the task performance. Such network differs for the involvement of the parietal cortices, which increases in strength near to the movement imagination onset for the SCI when compared to the normal population. For the second experiment, the results collected in a population of 10 subjects suggested that the most consistently activated structure in social interaction paradigms is the orbitofrontal region (roughly described by the Brodmann area 10) during the condition of competition. Conclusion: As a whole, these results suggest that the EEG hyperscanning methodology opens a new way to address the analysis of brain functions, allowing to study brain activity of group of humans during real-life social interactions. This technology can add new and useful instruments to the analysis of neural substrates of the human social behavior. Acknowledgments: This study was performed with the support of the European Union, through the COST program NEUROMATH (BM0601), and of the Compagnia San Paolo project SOCIAL AND EMOTIVE HYPERBRAINS.