Level Of Spinal Cord Injury Research Articles

The Video-Urodynamic and Electrophysiological Characteristics in Patients With Traumatic Spinal Cord Injury.

PurposeTo investigate the video-urodynamic and pelvic floor electrophysiological characteristics in patients with traumatic spinal cord injury (SCI).MethodsThis retrospective reviewed the clinical records, urodynamic and pelvic floor electrophysiological data of 647 patients with traumatic SCI and out of spinal shock. Patients were classified based on American Spinal Injury Association (ASIA) Impairment Scale and urodynamic findings.ResultsOf the 647 patients, detrusor overactivity (DO) with or without detrusor sphincter dyssynergia (DSD) was found in 79.5%, 61%, 35.2%, 35%, and 19.2% of patients with cervical, thoracic (T1–9), thoracic (T10–12), lumbar, and conical cauda injury, respectively. Other patients manifested detrusor areflexia (DA). Patients with DO and/or DSD had a longer duration of SCI at each injury level than patients with DA. In suprasacral injury patients with DA, 63.0% (58 of 92) had a normal bulbocavernosus reflex (BCR) response. Compared with patients without bladder sensation (BS), bladder capacity during urine leakage was far higher in those with BS. The manifestation of BCR and somatosensory-evoked potential (SEP) was associated with the level of injury.ConclusionsThis study showed a significant correlation between the level of SCI and video-urodynamic findings, but clinical examination cannot by predict bladder function; urodynamic testing is also necessary. In addition, the role of BCR and SEP for guiding bladder management is limited. Moreover, BS is important for urinary control in patients with traumatic SCI.

COVID-19 in spinal cord injury patients at a veterans administration hospital: A case series

Objective To describe the clinical features and disease course of COVID-19 in veterans with spinal cord injury (SCI). Design Case series of consecutive veterans with SCI treated at a single center. Setting SCI Unit at an urban Veterans Administration hospital at the epicenter of the COVID-19 pandemic in the US. Participants Seven SCI veterans with confirmed COVID-19 infection by PCR; all veterans were male, mean age was 60.6. Five had cervical level of injury, and five had complete injury (AIS A). Six veterans had a BMI > 22; three had chronic obstructive pulmonary disease; three had chronic kidney disease. Interventions None. Outcome Measures Presence of co-morbidities, diagnostic values, and clinical findings. Results Each case presented differently; the most common presenting sign was fever. In the three individuals with critical and fatal infection, pre-existing comorbidities were more common and inflammatory markers were markedly elevated. Conclusion Level and completeness of SCI did not appear to correlate with COVID-19 severity, as mild and asymptomatic illness was noted in persons with high grade SCI. As has been shown to be the case in the general population, pre-existing comorbidities are the most reliable predictors of severe SARS-CoV-2 infection currently available for persons with chronic SCI. Contrary to concerns that SCI may mask the cardinal signs of COVID-19, such as fever and cough, by way of compromised thermoregulation and thoracoabdominal musculature, such signs were common in our series. To facilitate early detection, prompt treatment, and minimized viral spread, the implementation of preventive strategies by SCI units is recommended.

Evaluation of Functional Independence in Cervical Spinal Cord Injury: Implications for Surgery to Restore Upper Limb Function

To help individuals make informed choices regarding the optimal type and timing of restorative surgical treatment for cervical spinal cord injury (SCI), more precise information is needed on their ability to perform activities of daily living. The goal of this work was to describe functional independence achieved by individuals with differing levels of cervical SCI. Using the comprehensive European Multicenter Study of Spinal Cord Injury dataset, analysis was undertaken of individuals with traumatic SCI, motor-level C5-C8. Data on feeding, bladder management, and transfers (bed to wheelchair) were compared between individuals with different levels of injury. Subgroup analyses of symmetrical and asymmetrical SCI and between complete and incomplete SCI were performed. The impact of age, sex, and time postinjury on functional independence was ascertained. Data were available for individuals with symmetrical (n= 204) and asymmetrical (n= 95) patterns of SCI. Independence with feeding, urinary function, and transfer ability was increased in individuals with strong finger flexion. Unexpectedly, the presence of strong elbow extension did not uniformly result in the ability to transfer independently. There was no change in any of the analyzed activities between 6 and 12 months postinjury. People with cervical SCI who gain finger flexion have greater independence with feeding, urinary, and transfer activities. Restoration of finger flexion should be a reconstructive priority for individuals with midcervical-level SCI. Prognostic IV.

Prevalence of sleep-disordered breathing in people with tetraplegia-a systematic review and meta-analysis.

Systematic review with meta-analysis. To determine the prevalence of sleep-disordered breathing (SDB) in people with tetraplegia and to identify the characteristics associated with SDB. A systematic literature search using Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and grey literature sources was conducted using a combination of spinal cord injury (SCI) and SDB related terms. Articles were restricted to publication dates between 1/1/2000 and 4/9/2020 and with objectively measured SDB with an overnight sleep study. The frequency of SDB stratified by the apnoea hypopnea index (AHI) was extracted and weighted averages, using a random effects model, were calculated with 95% confidence intervals. Sub-group analyses were performed where possible. Twelve articles were included in the review; of these nine were included in meta-analysis (combined sample = 630). Sample sizes and case detection methods varied. Reported SDB prevalence rates ranged from 46 to 97%. The prevalence of at least mild (AHI ≥ 5), moderate (AHI ≥ 15) and severe (AHI ≥ 30) SDB were 83% (95% CI = 73-91), 59% (46-71) and 36% (26-46), respectively. Sub-group analyses found that prevalence increased with age (p < 0.001). There were no statistically significant differences in SDB prevalence by sex (p = 0.06), complete/incomplete SCI (p = 0.06), body mass index (p = 0.07), acute/chronic SCI (p = 0.73) or high/low level of cervical SCI (p = 0.90). Our results confirm that SDB is highly prevalent in people with tetraplegia, and prevalence increases with age. The high prevalence suggests that routine screening and subsequent treatment should be considered in both acute and community care.

Cortical morphometric changes associated with completeness, level, and duration of spinal cord injury in humans: A case-control study.

ObjectiveThis study investigated how the injury completeness, level, and duration of spinal cord injury (SCI) affect cortical morphometric changes in humans.MethodsT1‐weighted images were acquired from 59 SCI patients and 37 healthy controls. Voxel‐based morphometry analyses of the gray matter volume (GMV) were performed between SCI patients and healthy controls, complete SCI and incomplete SCI, and tetraplegia and paraplegia. Correlation analyses were performed to explore the associations between GMV and clinical variables in SCI patients.ResultsCompared to healthy controls, SCI patients showed decreased GMV in bilateral middle frontal gyrus, left superior frontal gyrus (SFG), left medial frontal gyrus in the whole‐brain analysis, while increased GMV in right supplementary motor area and right pallidum in ROI analysis. The complete SCI had lower GMV in left primary somatosensory cortex (S1) and higher GMV in left primary motor cortex compared with incomplete SCI. Lower GMV was identified in left thalamus and SFG in tetraplegia than that in paraplegia. Moreover, time since injury was positive with the GMV in right pallidum, positive correlations were observed between the GMV in bilateral S1 and total motor and sensory scores, whereas the GMV in left cuneus was negatively correlated with total motor and sensory scores in SCI patients.ConclusionsThe study provided imaging evidence for identifying cerebral structural abnormalities in SCI patients and significant differences in complete/incomplete and paraplegia/tetraplegia subgroups. These results suggested brain structural changes occur after SCI and these changes may depend on the injury completeness, level, and duration.

Changes in Musculoskeletal Discomfort and Postural Alignment According to the Height of the Worktable When VDT Activities were Performed by Patients in a Wheelchair with C6 and T6 Spinal Cord Injuries

Purpose: This purpose of the study was to identify the effects of computer worktable heights on musculoskeletal changes in the neck and upper extremities and postural alignment in patients with C6 and T6 level spinal cord injuries. Materials and Methods: The participants in the present study were patients diagnosed with AIS A. The level of the worktable was set 5 cm below the elbow, at elbow level, and 5 cm above elbow level. Subjective musculoskeletal discomfort (Borg-RPE) was measured at the end of the experiment. To compare the side posture for the wheelchair axle, patients with C6 and the T6 injuries were selected to measure the angle of the centerline for the axle, the tip of the chin, and the postural change for the tragus of the ear. Results: First, in the patient with C6 injuries, the Borg-RPE scores decreased when the worktable height was 5 cm above the elbow, whereas, in the patient with T6 injuries, the Borg-RPE scores decreased when the worktable height was decreased. Second, in the patient with C6 injuries, the chin tip and tragus of the ear were close to the center of the wheelchair when the height of the worktable was 5 cm above the elbow in the lateral position. In the patient with T6 injuries, there was no difference in lateral posture according to the height of the worktable. Conclusion: To reduce musculoskeletal system discomfort in patients during video display terminal (VDT) work, it is necessary to set the worktable height higher than the elbow standard for patients with C6 injuries and lower than elbow height for patients with T6 injuries. In the case of posture change, in the patient with C6 injuries, the higher the worktable height, the more the neck and head changed from forward flexion to a neutral posture.

IMPACT OF ACTIVE REHABILITATION ON WHEELCHAIR DISTANCE IN MEN WITH SPINAL CORD INJURY AT THE CERVICAL OR THORACIC LEVELS

The aim of the study was to evaluate the effect of Active Rehabilitation (AR) on wheelchair distance in men with spinal cord injury (SCI) at the cervical or thoracic levels. The research group consisted of 30 men with cervical or thoracic SCI. All the participants completed the "1st level" rehabilitation camp in Spała (12 days). A modified Cooper test was used twice: the day before and the day after the AR camp. AR had increased the distance covered in a wheelchair in men with thoracic (18%) and cervical (29%) SCI. The percentage of change in the Cooper test result due to AR has a statistically significant dependency on the degree of impairment of spinal cord function according to the ASIA scale (parametric test: p=0.0131, nonparametric test p=0.0018). The level of SCI does not significantly differentiate this variable (parametric test: p=0.3418, nonparametric test p=0.0673). Contrary to expectations, men with SCI at cervical level improved more, which suggests that AR is a valuable therapeutic component in the rehabilitation of patients with SCI. The wheelchair distance improvement due to AR depends more on the degree of impairment of the spinal cord function than on the level of the SCI itself.

Prospective Study to Evaluate the Incidence of Deep-Vein Thrombosis in Patients with Acute Traumatic Spinal Cord Injury

Introduction: Deep-vein thrombosis (DVT) is one of the precarious complications of spinal cord injury (SCI). The present study was aimed to determine the incidence of DVT in acute traumatic SCI in the Indian population, factors associated with DVT, and to evaluate the role of D-dimer and color Doppler in establishing the diagnosis. Patients and Methods: Fifty patients with acute SCI presenting to a tertiary care center within 48 h of injury were clinically evaluated for the level, extent, and severity of SCI according to the ASIA standards. The local examination for the assessment of DVT was conducted. D-dimer test and color Doppler for DVT were performed at initial presentation, on day 7 and 14, 1 month, 3 months, and 6 months. Results: Three patients developed DVT between 14 days to 1 month. Overall DVT incidence was found to be 6%. Neurological level (P &lt; 0.05) and the severity of the deficit (P &lt; 0.001) were found to be associated with DVT. Patients with DVT had significantly more thigh and calf circumference at 1 month. Significantly higher levels of D-dimer were observed right from initial presentations to 6 months. Color Doppler was positive in all the three cases of DVT. Conclusions: The incidence of DVT is low in SCI patients in India, but it is not a rare complication. The occurrence of DVT has a significant correlation with factors such as the level and severity of injury. Frequent clinical examinations including the thigh and calf circumference along with D-dimer level estimation are good screening indicators, and color Doppler is an effective tool for establishing a definitive diagnosis of DVT in SCI patients.

Clinical Study on Evaluation of Autonomic Nervous Dysfunction Based on Imaging Urodynamic Examination with Slow Filling and Synchronous Blood Pressure Monitoring in the Patients with Cervicothoracic Spinal Cord Injury

Objective: Explore the rule of autonomic nervous dysfunction in the patients with urination disorder after high level spinal cord injury, and seek a safe, objective and accurate method to evaluate autonomic nervous function. Patients and Method: 48 patients with dysuria after cervicothoracic SCI were selected. Before, during and after imaging urodynamic examination with slow filling in supine position, blood pressure and ECG were monitored simultaneously. The symptoms of sweating, shivering, headache, flushing and chills were observed and recorded. The study of the relationship among the changes of blood pressure, heart rate and urodynamic indexes and the above symptoms was analyzed. Results: They were divided into three groups: group A (no obvious abnormality), group B (hyperactivity) and group C (hypoactivity) according to their BP, HR and existing the symptoms or not. Conclusion: The incidence of autonomic dysfunction in the high level SCI patients with dysuria was very high (79.17%), most of them were hyperactivity, and a few were low function. The changes of SBP and DBP in the hypoactivity group all appeared an increasing and then declining trend, while the change of HR in the low function one was lower than normal and decreased continuously. The main inducements of AD are neurogenic detrusor overactivity, detrusor sphincter dyssynergia, elevated abdominal pressure and abnormal bladder sensitivity. The asymptomatic patients had a higher occurrence rate (43.75%). Only by imaging urodynamic examination with slow filling and synchronous blood pressure monitoring, can autonomic nervous function of the patients be evaluated safely, objectively, early and accurately.

AN ANALYSIS FROM THE PERSPECTIVE OF BIOMECHANICS AND KINESIOLOGY OF A MECHANICAL FUNCTIONAL ORTHESIS FOR SPINAL INJURY LEVEL C6 AND C7

The spinal cord injury is characterized by damage to the spinal canal, which causes various complications in the individual’s life, whether physical, psychological and / or social. The incorporation of Assistive Technology consists of one of the forms of care and of increasing the quality of life of people with severe disabilities, such as quadriplegia. In the present study, there is the presentation of the mechanical functional orthosis for tetraplegic spinal cord injury level C6 and C7, triggered by the contraction of the extensor muscles of the wrist, flexors or extensors of the elbow, kinesiological functions compatible with the remaining functions observed in dermatomes. Understanding the important effects of spinal cord injury on affected patients, it is considered that the use of resources and products that aim to maintain, restore and / or maximize functionality is a primary factor for improving occupational performance. With this in mind, the orthosis presented in this work corroborates this scope, being a unique factor for engagement and return in the performance of activities of daily living, in addition to assisting in the rehabilitation process of these people.

Injury classification and level detection of the spinal cord based on the optimized recurrent neural network

Abstract Objectives Spinal cord damage is one of the traumatic situations in persons that may cause the loss of sensation and proper functioning of the muscles either temporarily or permanently. Hence, steps to assure the recovery through the early functioning and precaution could safe-guard a proper interceptive. To ensure the recovery of spinal cord damage through optimized recurrent neural network. Methods The research on the spinal cord injury classification and level detection is done using the CT images, which is initially given to the segmentation that is done using the adaptive thresholding methodology. Once the segments are formed, the disc is localized using the sparse fuzzy C-means clustering approach. In the next step, the features are extracted from the localized disc and the features include the connectivity features, statistical features, image-level features, grid-level features, Histogram of Oriented Gradients (HOG), and Linear Gradient Pattern (LGP). Then, the injury detection is done based on the Crow search Rider Optimization algorithm-based Deep Convolutional Neural Network (CS-ROA-based DCNN). Once the result regarding the presence of the injury is obtained, the injury-level classification is done based on the proposed Deep Recurrent Neural Network (Deep RNN), and in case of the absence of injury, the process is terminated. Therefore, the injury detection classifier derives the level of the injury, such as normal, wedge, biconcavity, and crush. Results The experimentation is carried out using an Osteoporotic vertebral fractures database. The performance of the injury level detection based on the proposed model is evaluated based on accuracy, sensitivity, and specificity. The proposed model achieves the maximal accuracy of 0.895, maximal sensitivity of 0.871, and the maximal specificity of 0.933 with respect to K-Fold. Conclusions The experimental results show that the proposed model is better than the existing models in terms of accuracy, sensitivity, and specificity.

Ultrashort Wave Combined with Human Umbilical Cord Mesenchymal Stem Cell (HUC-MSC) Transplantation Inhibits NLRP3 Inflammasome and Improves Spinal Cord Injury via MK2/TTP Signalling Pathway.

Objective To investigate the curative effects of HUC-MSCs combined with USW on spinal cord injury (SCI) and the effects on inflammatory microenvironment and to explore the regulatory mechanisms of MK2/TTP signalling pathway and NLRP3 inflammasome. Methods The SCI rat model was established using the modified Allen method; rats were administered with USW, HUC-MSCs, and combination therapy of USW and HUC-MSCs; the therapeutic efficacies in each group of rats were monitored and represented in BBB score. SCI levels were observed using HE staining and IF. The microglia polarisation state and released contents of inflammatory factors were detected. IF and Western Blotting were performed on to detect the expression levels of MK2/TTP signalling pathway and NLRP3 inflammasome-related proteins. Furthermore, the regulatory mechanisms of MK2/TTP pathway and NLRP3 were explored by performing on the in vitro study. Results Combination therapy of USW and HUC-MSCs was found of significant efficacy on improving motor functions of SCI rats, and it was further proved that this combination therapy can reduce spinal cord injury in SCI rats, of which USW plays a more important role. While transplantation of HUC-MSCs can promote microglial cells developing to SCI repair, and M2 microglial cells were taking advantages gradually. The combination therapy can inhibit the expression of MK2; downregulate NLRP3 inflammasome; suppress the expression levels of pro-caspase-1, pro-IL-1β, and pro-IL-18; and simultaneously suppress the release of IL-1β and IL-18, thereby reducing spinal cord neurons apoptosis. It was found that the steady state of microglial polarisation maintained by combined treatment of USW and HUC-MSCs was destroyed with the upregulation of MK2 expression in cells, of which, M1 type microglial cell was dominant and the increased contents of inflammatory factors were detected. However, overexpressed MK2 relieved the inhibition of NLRP3 expression by TTP. Conclusions Combination therapy of USW and HUC-MSCs can downregulate NLRP3 expression, relieve inflammatory responses, improve immune microenvironment, and rescue spinal cord injury via suppressing phosphorylation level of MK2.

Spinal cord injury level and Phrenic Nerve Conduction Studies do not predict diaphragm pacing success or failure- all patients should undergo diagnostic laparoscopy

BackgroundDiaphragm Pacing(DP) demonstrates benefits over mechanical ventilation(MV) for spinal cord injured(SCI) patients. The hypothesis of this report is that phrenic nerve conduction study(PNCS) results cannot differentiate success or failure in selection of patients for DP. Direct surgical evaluation of the diaphragm should be performed. MethodsObservational report of prospective databases of patients undergoing laparoscopic evaluation of their diaphragms to assess for ability to stimulate to cause contraction for ventilation. ResultsIn 50 SCI patients who could not be weaned from MV, PNCS results showed latencies in stimulated patients (n = 44) and non-stimulated(n = 6) overlapped (7.8 ± 2.5 ms vs 9.4 ± 2.8 ms) and the null hypothesis cannot be rejected (p-value>0.05). Amplitudes overlapped (0.4 ± 0.2 mV vs 0.2 ± 0.2 mV) and the null hypotheses cannot be rejected (P-value >0.05). In 125 non SCI patients with diaphragm paralysis, there were 78(62.4%) with false negative PNCS. ConclusionPNCS are inadequate pre-operative studies. Direct laparoscopic evaluation should be offered for all SCI patients to receive the benefit of DP.

Shoulder magnetic resonance imaging findings in manual wheelchair users with spinal cord injury

Objective: To investigate the prevalence of rotator cuff and long head of the biceps pathologies in manual wheelchair (MWC) users with spinal cord injury (SCI). Design: Cross-sectional study. Setting: Outpatient clinic at a tertiary medical center. Participants: Forty-four adult MWC users with SCI (36 men and 8 women) with an average age (SD) of 42 (13) years. SCI levels ranged from C6 to L1; complete and incomplete SCI. Outcome Measures: Participants’ demographic and anthropometric information, presence of shoulder pain, Wheelchair User’s Pain Index (WUSPI) scores, and magnetic resonance imaging findings of shoulder pathologies including tendinopathy, tendon tears, and muscle atrophy. Results: Fifty-nine percent of the participants reported some shoulder pain. The prevalence of any tendinopathy across the rotator cuff and the long head of biceps tendon was 98%. The prevalence of tendinopathy in the supraspinatus was 86%, infraspinatus was 91%, subscapularis was 75%, and biceps was 57%. The majority of tendinopathies had mild or moderate severity. The prevalence of any tears was 68%. The prevalence of tendon tears in the supraspinatus was 48%, infraspinatus was 36%, subscapularis was 43%, and biceps was 12%. The majority of the tears were partial-thickness tears. Participants without tendon tears were significantly younger (P < 0.001) and had been wheelchair user for a significantly shorter time (P = 0.005) than those with tendon tears. Conclusion: Mild and moderate shoulder tendinopathy and partial-thickness tendon tears were highly prevalent in MWC users with SCI. Additionally, the findings of this study suggest that strategies for monitoring shoulder pathologies in this population should not be overly reliant on patient-reported pain, but perhaps more concerned with years of wheelchair use and age.

Effects of experimental cervical spinal cord injury on peripheral adaptive immunity.

Adaptive immunity is critical for controlling infections, which are a leading cause of morbidity and mortality in patients with spinal cord injury (SCI). In rats and mice, compromised peripheral adaptive immune responses, as shown by splenic atrophy and lowered frequencies of peripheral lymphocytes, were shown to result from high-level thoracic SCI. However, whether cervical SCI, which is the most common level of SCI in humans, impairs adaptive immunity remains largely unknown. In the present study, we induced cervical SCI in rats at the C7/T1 level by clip compression and looked at changes in peripheral adaptive immunity at 2-, 10- and 20-weeks post-injury. Specifically, we quantified changes in the frequencies of T- and B- lymphocytes in the blood and the mandibular and deep cervical lymph nodes, which drain the cervical spinal cord. We also assessed changes in serum IgG and IgM immunoglobulin levels, as well as spleen size. We found a significant decline in circulating T- and B- cell frequencies at 10 weeks post-SCI, which returned to normal at 20 weeks after injury. We found no effect of cervical SCI on T- and B- cell frequencies in the draining lymph nodes. Moreover, cervical SCI had no effect on net spleen size, although injured rats had a higher spleen/body weight ratio than sham controls at all time points of the study. Lastly, IgG and IgM immunoglobulin declined at 2 weeks, followed by a significant increase in IgM levels at 10 weeks of injury. These data indicate that cervical SCI causes a significant imbalance in circulating lymphocytes and immunoglobulin levels at 2 and 10 weeks. As we discuss in this article, these findings are largely in line with clinical observations, and we anticipate that this study will fuel more research on the effect of adaptive immunity on SCI recovery.

The short-term effects of head-mounted virtual-reality on neuropathic pain intensity in people with spinal cord injury pain: a randomised cross-over pilot study.

Within-subject, randomised cross-over trial. To determine whether a commercially available 3D head-mounted (HMD) virtual reality (VR) device results in significant reductions in neuropathic pain compared to using a 2D screen device in people with spinal cord injury (SCI). Greenwich Hospital, Sydney, Australia. Sixteen men with established SCI and chronic neuropathic pain participated in a single-session randomised cross-over trial. We compared the effects of 3D HMD VR and a 2D screen application on SCI neuropathic pain intensity and levels of perceived presence. Participants reported significantly lower pain intensity after 3D HMD VR compared to 2D screen application (1.9 ± SD 1.8 versus 3.4 ± SD 1.6, mean 95% CI: 1.5, P < 0.0001). Participants reported significantly higher perceived levels of presence with the 3D HMD VR compared to 2D screen of (49.6 ± SD 8.9 versus 32.8 ± SD 11.1, mean 95% CI: 16.6, P < 0.0001). Increased perceived presence was associated with significantly lower pain intensity regardless of randomised sequencing of the two conditions (mean 95% CI: 0.06, P = 0.005). Effect size for pain reduction using 3D HMD VR was 0.80. We suggest that 3D HMD VR may provide neuropathic pain relief for people with SCI. Given the lack of cybersickness and ease of access, we propose that immersive VR could be a helpful adjunct to current pharmacotherapy. Further research is required to show that VR can be effective for more long-term reductions in SCI pain.

Qualidade de vida e lesão medular traumática: um estudo com uso de data sets internacionais

Avaliar a qualidade de vida (QV) de pessoas com lesão medular traumática (LMT) e sua associação com o tempo de LMT. Estudo quantitativo, analítico e transversal. Os dados foram coletados com dois instrumentos validados (questionário biosociodemográfico e Data Set de QV da International Spinal Cord Society). Amostra com 81 participantes, 81,5% do sexo masculino, com média de idade de 36±11,9 anos. A satisfação com a saúde psicológica apresentou maior escore (7,2), apesar disso, 86,4% estavam insatisfeitos ou completamente insatisfeitos com a QV geral. Não houve diferença quando comparado o nível da LMT com satisfação com a vida como um todo (p=0,237). A QV geral foi associada ao tempo de LMT (p=0,005), sugerindo que após cinco anos da LMT, as pessoas tendem a ficar mais satisfeitas com suas vidas. Este estudo mostrou que a maioria dos participantes com LMT apresentam-se insatisfeitos com a qualidade de vida.

Heart rate and blood pressure response improve the prediction of orthostatic cardiovascular dysregulation in persons with chronic spinal cord injury.

Unstable blood pressure after spinal cord injury (SCI) is not routinely examined but rather predicted by level and completeness of injury (i.e., American Spinal Injury Association Impairment Scale AIS classification). Our aim was to investigate hemodynamic response to a sit‐up test in a large cohort of individuals with chronic SCI to better understand cardiovascular function in this population. Continuous blood pressure and ECG were recorded from individuals with SCI (n = 159) and non‐injured individuals (n = 48). We found orthostatic hypotension occurred within each level and AIS classification (n = 36). Moreover, 45 individuals with chronic SCI experienced a drop in blood pressure that did not meet the criteria for orthostatic hypotension, but was accompanied by dramatic increases in heart rate, reflecting orthostatic intolerance. A cluster analysis of hemodynamic response to a seated position identified eight distinct patterns of interaction between blood pressure and heart rate during orthostatic stress indicating varied autonomic responses. Algorithmic cluster analysis of heart rate and blood pressure is more sensitive to diagnosing orthostatic cardiovascular dysregulation. This indicates blood pressure instability cannot be predicted by level and completeness of SCI, and the consensus statement definition of orthostatic hypotension is insufficient to characterize the variability of blood pressure and heart rate responses during orthostatic stress. Both blood pressure and heart rate responses are needed to characterize autonomic function after SCI.

Combining different evaluations of sensation to assess the afferent innervation of the lower urinary tract after SCI.

Retrospective cohort study. To study a combination of three evaluations of sensation in the lower urinary tract (LUT) in patients with spinal cord injury (SCI). University Antwerp Belgium, Unicenter study. Evaluation of perineal sensation with light digital touch, reporting of filling sensation during a standardised urodynamic investigation and determination of the electrical perception threshold (EPT) were evaluated in patients with SCI. 150 individuals were included: 97 men and 53 women, mean age 46 ± 17 years. Patients had different levels and completeness of SCI, and different techniques for bladder emptying. Seventy-four patients (49%) reported sensation to touch in the perineal area. Sensation of bladder filling was reported in different patterns by 81 patients (54%). EPT was determined in 69 patients of which 50 (72%) reported sensation in different patterns. The outcome of absence/presence of sensation between the three tests differed greatly: with perineal sensation absent 53% had filling sensation (p = 0.040) and 58% positive EPT (p = 0.009). With filling sensation absent 59% had EPT sensation (not significant). Perineal sensation was strongly associated with level and completeness of SCI, while a significant association existed for filling sensations FSF, FDV, SDV and EPT in the distal urethra. Our study shows that different evaluations of sensation in the LUT of individuals with SCI complement each other. and we therefore propose combined use in the urological evaluation of patients with SCI to allow a more complete picture of the LUT sensations.

Upper limb movement characteristics of children and youth with dyskinetic cerebral palsy – A sensor approach

People with spinal cord injury (SCI) may have their paralyzed muscles activated through functional electrical stimulation (FES). This neuromodulation technique has been used frequently to assist in controlling the movement of neuroprostheses. Electroencephalography (EEG) is able to trigger FES from the motor imagery captured through movements intentions. This research presents an isometric neuromuscular control system of the quadriceps muscle activated by EEG. Additionally, the detection of neuromuscular fatigue through the mechanomyography (MMG) technique is proposed, which is used to shut-off the system. A pilot study was performed on a chronic 42-year-old paraplegic (no voluntary contraction below the spinal cord injury level T8) volunteer. To do so, the training procedure for EEG signals was divided into the calibration and feedback phases. In the first one, four EEG channels and the Linear Discriminant Analysis (LDA) classifier were used to classify between motor imagery of the right leg and remain at rest. The maximum accuracy obtained during this stage was 77%. In the feedback phase, the volunteer was able to activate FES through brain–computer interface (BCI) in two tests (defined as Test 1 and Test 2) with the same procedure in different days. The closed-loop force control was tested with the setpoint of 2 kgf and 2.5 kgf and proved to be stable on both tests, successfully turning off the FES using the fatigue threshold from the MMG signal, being the main contribution of this work.