Introduction: Spinal cord injury (SCI) is associated with increased risk of cardiovascular and respiratory morbidity, which are major contributors to rehospitalization and mortality. While overall rehospitalization after SCI is well documented, few studies have focused specifically on early cardiopulmonary readmissions or linked these outcomes with prescription patterns using nationwide registry data. Methods: We linked the Swedish SCI register (SveReh) to the National Patient Register and Prescribed Drug Register. Adults with new-onset SCI admitted for first-time inpatient rehabilitation between 2016 and 2020 were included (n = 1,196). The cohort was followed for 12 months after discharge. Outcomes were cardiovascular (ICD I) and respiratory (ICD J) readmissions. Kaplan-Meier and Cox regression analyses examined predictors (age, neurological level, and pre-SCI drug use). Prescription changes for cardiovascular drugs (ATC C), respiratory drugs (ATC R), and antibiotics (ATC J01) were analyzed 365 days before and after SCI using McNemar’s test. Results: Within 12 months, 42 persons (3.5%) were readmitted for cardiovascular and 43 (3.6%) for respiratory causes; >96% remained event-free. Older age predicted both cardiovascular (HR: 1.02 per year, 95% confidence interval [CI]: 1.00–1.05, p = 0.050) and respiratory readmissions (HR: 1.02, 95% CI: 1.00–1.04, p = 0.024). Neurological level was also associated with respiratory readmission, with the highest risk in C1–C4 tetraplegia. Prescription analyses (n = 1,173) showed significant increases in antibiotics (+27.7%), cardiovascular drugs (+7.2%), and respiratory drugs (+3.4%). Conclusion: Cardiovascular and respiratory readmissions within 1 year after SCI were uncommon but strongly influenced by age, and for respiratory causes, by neurological level. Marked increases in antibiotic prescriptions highlight infection burden, while cardiovascular prescribing reflected age-related comorbidity. These findings identify subgroups who may benefit from targeted preventive follow-up.

This study aimed to optimize intracortical microelectrode array implantation sites for grasp-related motor decoding by integrating anatomical, functional, and vascular imaging with preoperative 3D modeling. A participant with C5 tetraplegia underwent anatomical magnetic resonance imaging (MRI), diffusion-weighted imaging, and task-based functional MRI (fMRI) to identify grasp-related cortical regions while avoiding vasculature and speech-critical areas. Quicktome software was used to refine target selection by integrating structural connectivity and functional activation data. A 3D-printed skull and cortical model enabled preoperative planning, including craniotomy and electrode positioning simulations. Electrode placement was validated post-operatively using neural data collected from the implanted arrays during attempted movements of the arm and hand. Functional imaging identified distinct grasp-related activation in anterior intraparietal area (AIP), ventral premotor cortex (PMv), and inferior frontal gyrus (IFG). AIP was selected based on its strong connectivity with motor cortex and distinct functional activation. Subregions 6v and 6r of PMv, which exhibited robust grasp-related activity and were surgically accessible, were chosen over the posterior IFG region, which extended into a sulcus making implantation difficult. Post-surgically, the arrays enabled high-fidelity decoding of arm/hand movements, achieving a combined accuracy of 96%. This study presents a multi-modal approach for optimizing intracortical electrode placement by combining MRI-based anatomical mapping, fMRI-guided functional localization, connectivity information, and 3D surgical modeling. These findings demonstrate an effective method for identifying surgically feasible grasp network implant locations in a paralyzed individual. This is an essential step for brain-machine interface (BMI) systems that use grasp-related brain activity to command devices, such as neuromuscular stimulation systems for restoring upper limb function in individuals with spinal cord injury (SCI).

症例は65歳，男性．遠位胆管癌に対して亜全胃温存膵頭十二指腸切除術を施行した．病理診断では，腫瘍に腺癌成分と紡錘形化した細胞集団や小ロゼット構造を伴う分化度の低い腫瘍成分を認めた．神経内分泌腫瘍マーカーによる免疫組織化学的検査では，Chromogranin陽性，Synaptophysin陽性，CD56陽性，SSTR2陽性であった．腺癌成分と神経内分泌腫瘍（NEN）成分がそれぞれ30％以上有しており，総胆管mixed neuroendocrine-non-neuroendocrine neoplasm（MiNEN）と診断した．術後補助化学療法としてS-1療法を行った．術後9カ月目，急に下肢麻痺症状が出現した．胸椎転移の脊髄圧迫による脊髄麻痺を認め，胸椎後方除圧固定術にて麻痺症状は改善した．骨腫瘍の掻爬骨組織より神経内分泌癌（NEC）を認め，総胆管MiNENのNEN成分の胸椎転移と診断した．その後，高度な血小板低下を伴う多発肝転移の出現を認め，初回手術より約11カ月で死亡した．本症例では，骨転移組織がNEC成分であったことを確認しえた稀な総胆管MiNENの症例であるため報告する．

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.

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).

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.

Laryngectomized patients become obligate stoma-breathers, able to breathe with or without a tube, which may be either of silicone or plastic (rigid tube), particularly when ventilatory support is required. Silicone tubes are more comfortable, but only rigid tubes are suitable for mechanic ventilation. We present the case of a 57-year-old male who underwent a total laryngectomy with tracheoesophageal prosthesis placement in September 2022 as a treatment for laryngeal carcinoma. On December 31, 2022, the patient developed a demyelinating form of Guillain-Barre Syndrome, presenting with severe tetra paresis. A few days later, the patient experienced severe type 2 respiratory failure, requiring invasive ventilation. His condition improved, and during his stay in the Physical Medicine and Rehabilitation ward, he required only nocturnal ventilation through a rigid tube. During the day, a fenestrated silicone tube was used to allow phonation training. His neuromotor status improved, and after returning home, by June 2023, the patient discontinued ventilator use due to the discomfort caused by frequent tube changes. A Pulmonology assessment in July revealed normal respiratory parameters without invasive ventilation. For laryngectomized patients who require chronic ventilation, the use of a rigid tube for ventilatory support poses significant challenges. The continuous presence of the rigid tube can be uncomfortable and impair communication, while the constant insertion and removal of the tube may lead to reduced adherence to ventilatory support. The absence of a rigid tube during the day is crucial for patient comfort and speech/phonation training. Our patient’s decision to discontinue ventilation at home was influenced by the challenges posed by frequent tube changes. Fortunately, he recovered from his chronic respiratory insufficiency, allowing him to discontinue nocturnal ventilation without major complications. Further research is needed to address the ventilation challenges in laryngectomized patients, aiming to improve comfort, communication skills, and adherence to necessary ventilatory support.

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.

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

Abstract People 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.

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.

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.

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 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.

Abstract Human 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.

Multiple sclerosis (MS) is very little described in tropical environments. It represents the leading cause of non-traumatic neurological disability in young subjects. We report the case of a patient with MS, 31 years old with no particular medical history, progressively presented weakness of the 4 limbs followed by lumbar pain which regressed after 2 months under the effect of symptomatic treatment with corticosteroids. Three months later, he presented with dysarthria and gait disturbance. The neurological examination revealed a bilateral pyramidal syndrome and a kinetic-static cerebellar syndrome. Brain magnetic resonance imaging (MRI) has objectified bihemispheric hypersignals predominantly periventricular, internal capsule, lenticular nucleus, thalamus, frontal and parietal lobe in axial section on flair sequences. Biology showed inflammatory syndrome. The patient received boluses of methylprednisolone for one week. The clinical evolution was favorable with an EDSS score of 3 at discharge. We report a case of multiple sclerosis in the republic of guinea. The evolutionary mode was in favor of a second push of a relapsing form. The clinical evolution of our patient was favorable under corticosteroid therapy and the patient presented an EDSS score of 6 at discharge. MS is very little described in Guinea. The diagnosis is based on clinical and paraclinical arguments; corticosteroid therapy was the treatment of first choice in our context.

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.

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

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.