Traumatic Spinal Cord Research Articles

Decubitus Ulcers in Patients with Spinal Cord Injury in Different Hospitals of Lahore

BACKGROUND: Spinal cord damage is a debilitating nervous disorder that has a significant economic, social, and psychological burden on those who are affected as well as the healthcare system. The spinal cord can be damaged due to either trauma to the cord or spinal cord dysfunctions. Pressure injuries are the leading secondary complication in patients with spinal cord injuries. OBJECTIVE: The purpose of this research was to document the prevalence of decubitus ulcers in spinal cord injury patients. METHOD: It was a cross-sectional study that included a sample of 114 patients either male or female with traumatic spinal cord injury or non-traumatic spinal cord injury with age ranging from less than 12 years to greater than 89 years from various hospitals in Lahore. The sampling technique used was non-probability convenient sampling. Written consent was taken from all patients before the collection of data. Pressure ulcer assessment was done using the European pressure ulcer prevalence study questionnaire. Data were analyzed using the IBM SPSS STATISTICS-25.0 version. Categorical variables were presented as frequencies and percentages, with the use of bar charts or pie charts. RESULTS: Out of 114 patients 68 patients were male (59.6%) and 46 were female (40.4%). This study concluded that 58.9% of patients had decubitus ulcers whether severe or at stage one of PU as a secondary complication of spinal cord injury. From the total sample of 114 patients 49.9% of participants had the most severe decubitus ulcers mostly on the sacrum which can lead to infection and requires surgical interventions such as debridement. Stage 1 decubitus ulcers were seen on the elbow and back. CONCLUSION: More than half of the patients included in this study had one or more pressure ulcers that can be damaging to their health and quality of life. In developed and developing countries pressure ulcers are widespread but are preventable.
 Key Words:
 Spinal cord injury, pressure ulcer, sacrum

Lesi Medulla Spinalis

Spinal cord injury is one of the main causes of neurological disability due to trauma. The most common cause of spinal cord trauma is due to traffic accidents, etc. Spinal cord trauma itself is classified into complete spinal cord trauma and incomplete spinal cord trauma. While the most common symptoms of spinal cord trauma are acute pain in the back of the neck, paraplegia, total motor sensory paralysis, loss of bladder control (urine retention, bladder distention), decreased sweating and vasomotor tone, decreased respiratory function, respiratory failure. Treatment of spinal cord injuries is primarily aimed at improving and maintaining sensory and motor function. Operative therapy is not recommended unless the patient has an indication for surgery. Incomplete spinal cord injuries tend to have a better prognosis than complete spinal cord injuries.

Protective Effect of Hydrogen-Rich Saline on Spinal Cord Damage in Rats.

The anti-inflammatory and anti-apoptotic effects of molecular hydrogen, delivered as hydrogen-rich saline (HRS), on spinal cord injury was investigated. Four-month-old male Sprague Dawley rats (n = 24) were classified into four groups: (1) control-laminectomy only at T7-T10; (2) spinal injury-dura left intact, Tator and Rivlin clip compression model applied to the spinal cord for 1 min, no treatment given; (3) HRS group-applied intraperitoneally (i.p.) for seven days; and (4) spinal injury-HRS administered i.p. for seven days after laminectomy at T7-T10 level, leaving the dura intact and applying the Tator and Rivlin clip compression model to the spinal cord for 1 min. Levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were measured in blood taken at day seven from all groups, and hematoxylin-eosin (H & E) and terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) were used to stain the tissue samples. IL-6 and TNF-α levels were significantly lower in the group treated with HRS following the spinal cord injury compared to the group whose spinal cord was damaged. A decrease in apoptosis was also observed. The anti-inflammatory and anti-apoptotic effect of IL-6 may be a clinically useful adjuvant therapy after spinal cord injury.

Lion’s Mane (Hericium erinaceus): A Potential Treatment for Neurologic Disorders in Veterinary Medicine

The use of the culinary and medicinal mushroom Lion’s Mane (LM) (Hericium erinaceus) has been extensively researched. Much of the recent research has been fueled by interest in using LM to prevent and treat neurological diseases such as cognitive decline, dementia, Parkinson’s disease, and Alzheimer’s disease and to stimulate peripheral nerve regeneration. This mushroom is rich in physiologically important components. The main bioactive phytochemicals extracted from LM’s fruiting body and mycelia are hericenones, erinacines, polysaccharides, and dilinoleoyl-phosphatidylethanolamine (DLPE). β-glucan polysaccharides are immuno-active and responsible for LM’s anti-cancer, immunomodulating, hypo-lipidemic, antioxidant, and neuroprotective actions. The hericenones and erinacines can cross the blood-brain barrier and stimulate nerve growth factor (NGF). Since NGF keeps the brain and nervous system regenerating and repairing itself, research has been focused on the effect of these compounds on brain and nervous system conditions. In veterinary medicine, supplementation of LM has potential in the treatment of many conditions, including peripheral nerve damage, dementia, cognitive decline, anxiety, and spinal cord trauma and degeneration.

Mature B-cell lymphoma with acute myelitis as the first presentation: a case report and literature review

BackgroundLymphomas are malignant tumors of the immune system that arise in lymphoid organs and can impact the central nervous system. However, lymphomas with acute myelitis as the first manifestation are exceedingly rare, and most of them are symptoms of spinal cord damage due to the lack of specificity in their clinical manifestations. The rate of early misdiagnosis is exceedingly high, and the prognosis is dire. Here, we report a case of mature B-cell lymphoma with acute myelitis as the first presentation and review the related literature.Case presentationIn this study, We report a case of a 70-year-old male patient with bilateral lower extremity weakness, bowel and bladder dysfunction, and recurrent fever. A paraureteral mass was seen beneath the right kidney on imaging, and the final pathological biopsy revealed: CD20 ( +), mature B-cell tumor, The patient refused to undergo additional tests to ascertain the type of lymphoma and subsequent therapy and asked to be discharged. In mid-November 2020, the patient died.ConclusionsThis case report shows that patients with lymphoma can present with acute myelitis as the first symptom, especially if they have recurrent fever, that conventional treatment for myelitis is ineffective, and that tumors are considered after other causes of myelitis have been ruled out. Furthermore, a focused search for tumor-related evidence, as well as early identification and therapy, may help patients live longer lives.

An emerging role of inflammasomes in spinal cord injury and spinal cord tumor.

Spinal cord injury (SCI) and spinal cord tumor are devastating events causing structural and functional impairment of the spinal cord and resulting in high morbidity and mortality; these lead to a psychological burden and financial pressure on the patient. These spinal cord damages likely disrupt sensory, motor, and autonomic functions. Unfortunately, the optimal treatment of and spinal cord tumors is limited, and the molecular mechanisms underlying these disorders are unclear. The role of the inflammasome in neuroinflammation in diverse diseases is becoming increasingly important. The inflammasome is an intracellular multiprotein complex and participates in the activation of caspase-1 and the secretion of pro-inflammatory cytokines such as interleukin (IL)-1β and IL-18. The inflammasome in the spinal cord is involved in the stimulation of immune-inflammatory responses through the release of pro-inflammatory cytokines, thereby mediating further spinal cord damage. In this review, we highlight the role of inflammasomes in SCI and spinal cord tumors. Targeting inflammasomes is a promising therapeutic strategy for the treatment of SCI and spinal cord tumors.

Paroxysmal painful tonic spasms in neuromyelitis optica spectrum disorder

Recently, an association between painful tonic spasms (PTS) and Neuromyelitis Optica Spectrum Disorder (NMOSD) was established. To describe the clinical characteristics of PTS in NMOSD based on a video recording and to provide a literature review on the topic. We report a case of a 38years-old woman with a diagnosis of NMOSD and positive aquaporin-4 IgG antibody status who developed PTS five weeks after an episode of longitudinal extensive transverse myelitis (LETM). Repetitive, brief, and painful episodes of muscle contraction were observed on the patient's left hand, spreading to the left arm, and then extending to the four limbs. While pregabalin and topiramate had no influence on these episodes, the patient responded to carbamazepine (CBZ), without symptom recurrence after one year. PTS in association with LETM can be considered typical for NMOSD. Although the exact mechanism is unknown, ephaptic transmission after spinal cord damage and excitatory soluble factors released during acute inflammation responses are sought to be involved. Symptomatic treatment with CBZ achieved remission of spams in our case.

Bioinformatics-based diagnosis and evaluation of several pivotal genes and pathways associated with immune infiltration at different time points in spinal cord injury

ABSTRACT Spinal Cord Injury (SCI) is a devastating neurological event. To assess the degree of spinal cord damage and classify the injury, it is recommended to use the 2019 version of the AIS standard. The severity of trauma was evaluated using the Trauma Severity Score, and various classification systems have been proposed for injuries at different parts and segments of the spine. Understanding the regulated signaling pathways and immune processes following SCI can lead to a better understanding of SCI-induced biomarkers and their underlying mechanisms. In this study, two gene expression datasets (GSE464 and GSE45006) from the Gene Expression Omnibus database were utilized. Differential gene expression and co-expression network analysis were performed, revealing 370 shared genes in the 3-day group and 111 shared genes in the 14-day group after SCI. The study used functional enrichment analysis methods such as Gene Set Enrichment Analysis, Gene Ontology, and Kyoto Encyclopedia of Genes and Genomes. The ssGSEA method was used to assess the levels and composition of immune infiltration in both the sham (control) and SCI groups. The single-cell transcriptomics dataset GSE182803 was analyzed to identify genes associated with immune marker cells. Four key genes (Ptgs2, Fn1, Ccl2, and Icam1) were identified in the 3-day group, while only one gene (Cyp51) was identified in the 14-day group after SCI. The findings offer significant insights into the immune-related genes and signaling pathways involved in secondary SCI at different time points and hold potential for the development of intervention strategies for acute and chronic post-SCI.

Manajemen Anestesi pada Pasien dengan Tetraparese yang dilakukan Reseksi Tumor Cervikal Ekstradural (C1-3)

Cervical extradural tumor is one of the rare tumors and can cause progressive neurological problems. Neurological deficit in productive age greatly affects the patient's quality of life. Surgical management is carried out with the aim of reducing pain, improving neurological conditions, and improving the patient's quality of life. A 25-year-old woman had progressive tetraparesis since 2 months prior to admission, MRI showed an extradural mass compressing the spinal cord at the level of the C1-3. The surgery was performed under the principles of neuroanaesthesia. On postoperative assessment, motor strength function has improved significantly. A extradural tumor patient was excision by operation with 850 mm bleeds and good recovery with improvement motoric function in all extremities Good perioperative management is needed in patients with spinal tumors, especially patient with tumors on the cervical levels. The anticipation of iatrogenic spinal cord trauma and bleeding has to be maintained during the surgery. Neurological evaluation and rehabilitation of patients is carried out by involving a multidisciplinary team. Spinal cord tumour with excise in neurosurgery at the right time and good perioperative neuroanesthesia will good outcome and improve neurologicals deficit.

The Role of Magnetic Transcranial Stimulation in the Diagnosis and Post-Surgical Follow-Up of Cervical Spondylotic Myelopathy.

Degenerative cervical myelopathy (DCM) consists of spinal cord damage due to its compression through the cervical spine. The leading cause is degenerative. The diagnosis is clinical, and the therapeutic approach is usually surgical. Confirmation of the diagnostic suspicion is done by magnetic resonance imaging (MRI); however, this test lacks functional information of the spinal cord, the abnormality of which may precede involvement in neuroimaging. Neurophysiological examination using somatosensory evoked potentials (SSEPs) and transcranial magnetic stimulation (TMS) allows for an evaluation of spinal cord function, and provides information in the diagnostic process. Its role in the post-surgical follow-up of patients undergoing decompressive surgery is being studied. We present a retrospective study of 24 patients with DCM and surgical decompression who underwent neurophysiological tests (TMS and SSEP) before, 6, and 12 months after surgery. The result of the TMS and the SSEP in the post-operative follow-up did not correlate with the clinical outcome, either subjective or measured by clinical scales at six months. We only found post-surgical improvement of central conduction times (CMCTs) in patients with severe pre-surgical motor impairment on TMS. In patients with normal pre-surgical CMCT, we found a transient worsening with return to baseline at the one-year follow-up. Most patients presented pre-surgical increased P40 latency at diagnosis. CMCT and SSEP were more related to clinical outcomes one year after the surgical procedure and were very useful in diagnosing.

Overexpression of the X-Linked Inhibitor of Apoptosis Protein (XIAP) in Neurons Improves Cell Survival and the Functional Outcome after Traumatic Spinal Cord Injury.

Mechanical trauma to the spinal cord causes extensive neuronal death, contributing to the loss of sensory-motor and autonomic functions below the injury location. Apoptosis affects neurons after spinal cord injury (SCI) and is associated with increased caspase activity. Cleavage of X-linked inhibitor of apoptosis protein (XIAP) after SCI may contribute to this rise in caspase activity. Accordingly, we have shown that the elevation of XIAP resulted in increased neuronal survival after SCI and improved functional recovery. Therefore, we hypothesise that neuronal overexpression of XIAP can be neuroprotective after SCI with improved functional recovery. In line with this, studies of a transgenic mice with overexpression of XIAP in neurons revealed that higher levels of XIAP after spinal cord trauma favours neuronal survival, tissue preservation, and motor recovery after the spinal cord trauma. Using human SH-SY5Y cells overexpressing XIAP, we further showed that XIAP reduced caspase activity and apoptotic cell death after pro-apoptotic stimuli. In conclusion, this study shows that the levels of XIAP expression are an important factor for the outcome of spinal cord trauma and identifies XIAP as an important therapeutic target for alleviating the deleterious effects of SCI.

Beyond Pattern Recognition: Radiology-Pathology-Clinical Correlation.

Radiology-pathology correlation is essential for multidisciplinary collaboration in diagnosis and understanding the mechanism of CNS damage in infectious processes. The microscopic acute inflammatory processes are well established and are supplemented by a variety of less-invasive microbial and immunohistochemical investigations. Understanding the pathogenesis of pathogen spread and neuroinvasion, vascular and immune-mediated brain, and spinal cord damage are essential for interpreting radiological images.

Mouse Model of Spinal Cord Hypoperfusion with Immediate Paralysis Caused by Endovascular Repair of Thoracic Aortic Aneurysm.

A clinically relevant mouse model of thoracic endovascular aortic repair-induced ischemic spinal cord injury has been lacking since the procedure was first employed in 1991. The hypothesis was that ligation of mouse intercostal arteries would simulate thoracic endovascular aortic repair-induced ischemic spinal cord injury and behavioral deficit. The aim was to create a mouse model of thoracic endovascular aortic repair-induced spinal cord hypoperfusion by ligating five pairs of mouse intercostal vessels. Mice were divided into sham (n = 53) and ligation (n = 60) groups. The procedures called for double ligation of three pairs and single ligation of two pairs of thoracic intercostal arteries in adult C57BL/6 mice. A laser Doppler probe was used in vivo on the spinal cords and intercostal arteries to document the extent of arterial ligation and spinal cord hypoperfusion. The Basso Mouse Scale for Locomotion, histological studies, and electron microscopy demonstrated postligation locomotive and histopathological changes. Ligation induced a significant and instantaneous drop in blood flow in the intercostal arteries (% change; mean = -63.81; 95% CI, -72.28 to -55.34) and the thoracic spinal cord (% change; mean = -68.55; 95% CI, -80.23 to -56.87). Paralysis onset was immediate and of varying degree, with behavioral deficit stratified into three groups: 9.4% exhibited severe paralysis, 37.5% moderate paralysis, and 53.1% mild paralysis at day 1 (n = 32; P < 0.001). Mild and moderate paralysis was transient, gradually improving over time. Severe paralysis showed no improvement and exhibited a higher mortality rate (83%; n = 15 of 18) compared to moderately (33%; n = 6 of 18) and mildly (24%; n = 6 of 25) paralyzed mice (P < 0.001). The overall ligation group survival rate (84%; n = 46 of 55) was significantly lower than the sham group (100%; n = 48 of 48) with P = 0.003. The mouse model generates reproducible spinal cord hypoperfusion and accompanying histopathological ischemic spinal cord damage. The resulting anatomical changes and variable behavioral deficits mimic the variability in radiological and clinical findings in human patients.

AAV Vector Mediated Delivery of NG2 Function Neutralizing Antibody and Neurotrophin NT-3 Improves Synaptic Transmission, Locomotion, and Urinary Tract Function after Spinal Cord Contusion Injury in Adult Rats.

NG2 is a structurally unique transmembrane chondroitin sulfate proteoglycan (CSPG). Its role in damaged spinal cord is dual. NG2 is considered one of key inhibitory factors restricting axonal growth following spinal injury. Additionally, we have recently detected its novel function as a blocker of axonal conduction. Some studies, however, indicate the importance of NG2 presence in the formation of synaptic contacts. We hypothesized that the optimal treatment would be neutralization of inhibitory functions of NG2 without its physical removal. Acute intraspinal injections of anti-NG2 monoclonal antibodies reportedly prevented an acute block of axonal conduction by exogenous NG2. For prolonged delivery of NG2 function neutralizing antibody, we have developed a novel gene therapy: adeno-associated vector (AAV) construct expressing recombinant single-chain variable fragment anti-NG2 antibody (AAV-NG2Ab). We examined effects of AAV-NG2Ab alone or in combination with neurotrophin NT-3 in adult female rats with thoracic T10 contusion injuries. A battery of behavioral tests was used to evaluate locomotor function. In vivo single-cell electrophysiology was used to evaluate synaptic transmission. Lower urinary tract function was assessed during the survival period using metabolic chambers. Terminal cystometry, with acquisition of external urethral sphincter activity and bladder pressure, was used to evaluate bladder function. Both the AAV-NG2Ab and AAV-NG2Ab combined with AAV-NT3 treatment groups demonstrated significant improvements in transmission, locomotion, and bladder function compared with the control (AAV-GFP) group. These functional improvements associated with improved remyelination and plasticity of 5-HT fibers. The best results were observed in the group that received combinational AAV-NG2Ab+AAV-NT3 treatment.SIGNIFICANCE STATEMENT We recently demonstrated beneficial, but transient, effects of neutralization of the NG2 proteoglycan using monoclonal antibodies delivered intrathecally via osmotic mini-pumps after spinal cord injury. Currently, we have developed a novel gene therapy tool for prolonged and clinically relevant delivery of a recombinant single-chain variable fragment anti-NG2 antibody: AAV-rh10 serotype expressing scFv-NG2 (AAV-NG2Ab). Here, we examined effects of AAV-NG2Ab combined with transgene delivery of Neurotrophin-3 (AAV-NT3) in adult rats with thoracic contusion injuries. The AAV-NG2Ab and AAV-NG2Ab+AAV-NT3 treatment groups demonstrated significant improvements of locomotor function and lower urinary tract function. Beneficial effects of this novel gene therapy on locomotion and bladder function associated with improved transmission to motoneurons and plasticity of axons in damaged spinal cord.

Valproic Acid Attenuates Oxidative Damage in Rat Spleen Tissue Induced By Spinal Cord Damage

Events such as oxidative stress caused by spinal cord injury (SCI) are a serious condition because they negatively affect many organs. Alternative treatment options for this type of injury are quite limited. In this study, we planned to investigate the effect of oxidative damage on the spleen tissue of rats with spinal cord damage and the protective role of valproic acid (VPA) in this damage. Sixteen Wistar albino rats were divided into two equal groups. No treatment was administered to the rats in Group 1 (SCI-(Control), but a single dose of 300 mg/kg intraperitoneally VPA was administered to the rats in Group 2 (SCI-VPA). Superoxide dismutase (SOD) activities, total antioxidant status (TAS) and total oxidant status (TOS) levels were examined as markers of oxidative stress in spleen tissues taken after decapitation of rats. VPA treatment increased the SOD and TAS level but decreased the TOS level, indicating improved oxidative damage and impaired enzymatic antioxidant levels in spleen tissue homogenate damaged by SCI. We have observed that VPA, which has many beneficial properties, has a significant healing effect on spleen tissue affected by SCI-induced oxidative stress.

Histopathological and immunohistochemical investigation of the effect of Shilajit in rats with experimental spinal cord injury.

This experimental study was designed to investigate the histopathological and immunohistochemical effects of Shilajit in rats with experimentally induced spinal cord injury (SCI). The rats were divided into three groups: Control group: The group in which spinal cord damage was created but no drug was administered. Low-dose group: This is the group in which intraperitoneal Shilajit is given at a dose of 150 mg/kg at the 1st h, 1st day, 2nd day, and 3rd day after spinal cord damage was induced. High-dose group: This is the group in which intraperitoneal Shilajit is given at a dose of 250 mg/kg at the 1st h, 1st day, 2nd day, and 3rd day after spinal cord damage was induced. Thin sections taken from the spinal cord after euthanasia were sent for histopathological and immunohistochemical examination. Histopathological examination of the high-dose group showed lower amounts of morphological findings compared to the low-dose group and control group. While a significant CD68 immune reaction was observed in the control group of rats with spinal injury, the positive immune reaction was found to be significantly decreased in the Shilajit-applied groups. It is thought that the use of Shilajit in SCI will reduce the effects of secondary damage in SCI and that its administra-tion to such patients will have positive effects on the results.

Conducting spinal cord injury model with clip compression in rodents: Pearls and pitfalls

Research on spinal cord injuries is an important and living topic that raises many critical questions that need to be addressed. While numerous articles have compiled and compared various models of spinal cord injuries, there is limited comprehensive guide with clear instructions available for researchers who are unfamiliar with clip compression model. This model creates acute compression damage in spinal cord, which aims to mimic the nature of traumatic spinal cord damage in humans. Purpose of this article is to share our experience on clip compression model, with experience gained from more than 150 animals, and to provide guidance for researchers with lack of experience who wish to design studies with this model. We have defined several key variables, as well as the difficulties that may arise when applying this model.−Proper preparation, good infrastructure and necessary tools and knowledge of anatomy related is essential to the success of this model.−Good exposure with non-bleeding surgical site is key factor for surgical step.−Postoperative care is particularly challenging, and researchers should consider extending their studies over a reasonable time period to ensure that appropriate care could be provided.

Engineering strategies and optimized delivery of exosomes for theranostic application in nerve tissue.

Severe injuries or diseases affecting the peripheral and central nervous systems can result in impaired organ function and permanent paralysis. Conventional interventions, such as drug administration and cell-based therapy, exhibit limited effectiveness due to their inability to preserve post-implantation cell survival and impede the deterioration of adjacent tissues. Exosomes have recently emerged as powerful tools for tissue repair owing to their proteins and nucleic acids, as well as their unique phospholipid properties, which facilitate targeted delivery to recipient cells. Engineering exosomes, obtained by manipulating the parental cells or directly functionalizing exosomes, play critical roles in enhancing regenerative repair, reducing inflammation, and maintaining physiological homeostasis. Furthermore, exosomes have been shown to restore neurological function when used in combination with biomaterials. This paper primarily focuses on the engineering strategies and delivery routes of exosomes related to neural research and emphasizes the theranostic application of optimized exosomes in peripheral nerve, traumatic spinal cord, and brain injuries. Finally, the prospects of exosomes development and their combination with other approaches will be discussed to enhance our knowledge on their theranostic effectiveness in neurological diseases.

Posterior spinal decompression in adults with spinal cord injury without traumatic compromise of the spinal canal: what is the data?

Spinal cord injury (SCI) can be caused by a variety of factors and its severity can range from a mild concussion to a complete severing of the spinal cord. Τreatment depends on the type and severity of injury, the patient's age and overall health. Reduction of dislocated or fractured vertebrae via closed manipulation or surgical procedures, fixation and removal of bony fragments and debris that compromise the spinal canal are indicated for decompression of the spinal cord and stabilization of the spine. However, when there is no obvious traumatic obstruction of spinal canal, the question arises as to whether laminectomy is needed to be performed to improve neurological outcome. A literature review covering all indexed studies published between 2013 and 2023 was performed using keywords to identify the patient group of interest (spinal cord injury, SCI, spinal cord trauma, cervical, thoracic, lumbar, thoracolumbar),central cord syndrome (CCS) and the interventions (laminectomy, laminoplasty, decompression, duroplasty). This review includes6 observational studies investigating the outcome of posterior spinal decompression in patients suffering from spinal cord injury without traumatic spinal cord stenosis. Most patients already had degenerative stenosis. From a total of 202, 151 patients (74.7%) improved neurologically by at least one grade at ASIA scale, after being treated with either laminectomy, laminoplasty, duroplasty or a combination of these techniques. Early decompression in SCI patients remains a reasonable practice option and can be performed safely, but no specific evidence supports the use of laminectomy alone. There is emerging evidence that intended durotomy followed by extended meningoplasty may improve the neurological outcome in patients suffering from SCI when meta-traumatic edema is apparent. However, the lack of high-quality evidence and results support the need for further research.

Design of LoRa Antenna for Wearable Medical Applications

The intraoral Tongue Drive System (iTDS) is a wireless assistive technology (AT) that may be operated using a variety of user-defined voluntary tongue motions. In this study, we introduce a novel arch-shaped iTDS that takes up the buccal shelf space in the mouth without constricting tongue motions. Damage to the central nervous system that causes upper limb paralysis. For instance, severe spinal cord injuries, certain strokes or multiple amputations of the upper limbs can make it very difficult for a lot of individuals to go about their everyday lives since they cause them to lose function, control, and independence. Because its muscles are strong and dexterous and do not quickly tire when not necessary to exert power, the tongue is an excellent choice for controlling an AT. Additionally, through cranial nerves, which are unaffected by a spinal cord damage, the tongue is directly attached to the brain. Furthermore, since the tongue movements may be totally hidden from view, TDS-based AT safeguard users’ privacy. In order to provide an effective solution, this paper proposed a novel antenna design with dual-band and implantability. The antenna is modelled in single-layer human muscle considering the feasibility and computational time. Then, the performance is evaluated through multi-layered human oral cavity model. A protective layer is established to prevent direct contact between the antenna and human body. Simulation results show that the proposed antenna has better reflection coefficient, impedance, and radiation pattern as compared with existing antennas.