Thoracic Spinal Cord Injury Patients Research Articles

Urodynamic findings and therapeutic approaches for neurogenic lower urinary tract dysfunction in patients with thoracic spinal cord injury.

To evaluate urodynamic examination results and treatment methods of neurogenic lower urinary tract dysfunction (NLUTD) in patients with traumatic thoracic spinal cord injury (SCI). Ninety-one patients with traumatic thoracic SCI were included in the study. The urodynamic analyses of the patients were conducted retrospectively using their laboratory outcomes. The patients were divided into subgroups according to the sensory innervation of the bladder (T1-10/T11-12), the preservation of sensory functions in the sacral segment (complete lesion/incomplete lesion), and the duration of injury (< 6months/ ≥ 6months) and evaluations in subgroups were carried out. A total of 91 patients (69 males, 22 females) were included in the study. When comparing between the subgroups, the sense of bladder fullness was preserved more in the T11-T12 group with a statistically significant difference (p < 0.001). While storage disorder, the rate of indwelling catheter use during hospitalization, bacterial growth of 105CFU/ml in the urine culture, and anticholinergic drug recommendation after urodynamic examination were higher in the complete lesion group, the rate of spontaneous/catheter-free voiding, the number of patients in which sense of bladder fullness was preserved-partially preserved, and alpha-blocker drug recommendation after urodynamic examination was higher in the incomplete lesion group, with a statistically significant difference in all parameters (all p values < 0.05). Our results demonstrate that there are differences in neurogenic lower urinary tract dysfunction features in subgroups of traumatic thoracic SCI patients. Regular urinary system evaluation and necessary changes in treatment should be carried out in this patient group.

Effects of upper limb ergometer on pulmonary functions among spinal cord injury patients

IntroductionSpinal cord injury is a serious condition that has a profound impact on pulmonary functions and quality of life. Ergometer training is a form of fitness training that seems to influence cardiorespiratory fitness among young individuals. The objective of the study was to evaluate the effect of upper limb ergometry on pulmonary functions in thoracic spinal cord injury patients.MethodsA randomised, parallel control trial was conducted by the lottery method. 44 patients (22 in each group), who had upper and lower thoracic spinal injuries, aged 25–45 years and of either sex were included. Patients were randomised into pro�gressive upper limb ergometer training (group A) and conventional therapy (group B), and training was continued for six weeks. Outcomes were measured by using a spirometer for pulmonary function tests, assessed at baseline and each week.ResultsA total of 44 participants were analysed in which the mean age in group A was (35.77 ± 5.58) years and in group B was (32.27 ± 6.85) years. Mann–Whitney U-test was used for intergroup comparison of baseline to end values of (FEV1, PEF and FVC). FEV1 was significantly improved post-intervention (&lt;i&gt;p&lt;/i&gt;-value = 0.008). Post-training PEF was significantly improved in both groups (&lt;i&gt;p&lt;/i&gt;-value = 0.001). FVC was also significantly improved (&lt;i&gt;p&lt;/i&gt;-value = 0.003) at the end of the sixth week.ConclusionsThe current study reports that upper limb ergometry has positive effects on spirometry values, as indicated by the improvements in the FVC, FEV1, and PEF values and pulmonary functions in thoracic spinal cord injury patients.

Altered Topological Properties of Grey Matter Structural Covariance Networks in Complete Thoracic Spinal Cord Injury Patients: A Graph Theoretical Network Analysis.

Purpose This study is aimed at investigating brain structural changes and structural network properties in complete spinal cord injury (SCI) patients, as well as their relationship with clinical variables. Materials and Methods Structural MRI of brain was acquired in 24 complete thoracic SCI patients (38.50 ± 11.19 years, 22 males) within the first postinjury year, while 26 age- and gender-matched healthy participants (38.38 ± 10.63 years, 24 males) were enrolled as control. The voxel-based morphometry (VBM) approach and graph theoretical network analysis based on cross-subject grey matter volume- (GMV-) based structural covariance networks (SCNs) were conducted to investigate the impact of SCI on brain structure. Partial correlation analysis was performed to explore the relationship between the GMV of structurally changed brain regions and SCI patients' clinical variables, including injury duration, injury level, Visual Analog Scale (VAS), American Spinal Injury Association Impairment Scale (AIS), International Classification of Functioning, Disability and Health (ICF) scale, Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS), after removing the effects of age and gender. Results Compared with healthy controls, SCI patients showed higher SDS score (t = 4.392 and p < 0.001). In the VBM analysis, significant GMV reduction was found in the left middle frontal cortex, right superior orbital frontal cortex (OFC), and left inferior OFC. No significant difference was found in global network properties between SCI patients and healthy controls. In the regional network properties, significantly higher betweenness centrality (BC) was noted in the right anterior cingulum cortex (ACC) and left inferior OFC and higher nodal degree and efficiency in bilateral middle OFCs, while decreased BC was noted in the right putamen in SCI patients. Only negative correlation was found between GMV of right middle OFC and SDS score in SCI patients (r = −0.503 and p = 0.017), while no significant correlation between other abnormal brain regions and any of the clinical variables (all p > 0.05). Conclusions SCI patients would experience depressive and/or anxious feelings at the early stage. Their GMV reduction mainly involved psychology-cognition related rather than sensorimotor brain regions. The efficiency of regional information transmission in psychology-cognition regions increased. Greater GMV reduction in psychology region was related with more severe depressive feelings. Therefore, early neuropsychological intervention is suggested to prevent psychological and cognitive dysfunction as well as irreversible brain structure damage.

Tracking the neurodegenerative gradient after spinal cord injury.

To quantify neurodegenerative changes along the cervical spinal cord rostral to a spinal cord injury (SCI) by means of quantitative MRI (qMRI) and to determine its relationship with clinical impairment. Thirty chronic SCI patients (15 tetraplegics and 15 paraplegics) and 23 healthy controls underwent a high-resolution T1-weighted and myelin-sensitive magnetization transfer (MT) MRI. We assessed macro- and microstructural changes along the cervical cord from levels C1 to C4, calculating cross-sectional spinal cord area, its anterior-posterior and left-right width and myelin content (i.e. MT). Regression analysis determined associations between qMRI parameters and clinical impairment. In SCI patients, cord area decreased by 2.67mm2 (p=0.004) and left-right width decreased by 0.35mm (p=0.002) per cervical cord level in the caudal direction when compared to the healthy controls. This gradient of neurodegeneration was greater in tetraplegic than paraplegics in the cross-sectional cervical cord area (by 3.28mm2, p=0.011), left-right width (by 0.36mm, p=0.03), and mean cord MT (by 0.13%, p=0.04), but independant of lesion severity (p>0.05). Higher lesion level was associated with greater magnitudes of neurodegeneration. Greater loss in myelin content in the dorsal columns and spinothalamic tract was associated with worse light touch (p=0.016) and pin prick score (p=0.024), respectively. A gradient of neurodegeneration is evident in the cervical cord remote from a SCI. Tract-specific associations with appropriate clinical outcomes highlight that remote neurodegenerative changes are clinically eloquent. Monitoring the neurodegenerative gradient could be used to track treatment effects of regenerative and neuroprotective agents, both in trials targeting cervical and thoracic SCI patients.

White Matter Microstructure Alterations in Patients With Spinal Cord Injury Assessed by Diffusion Tensor Imaging.

Compared to healthy controls, spinal cord injury (SCI) patients demonstrate white matter (WM) abnormalities in the brain. However, little progress has been made in comparing cerebral WM differences between SCI-subgroups. The purpose of this study was to investigate WM microstructure differences between paraplegia and quadriplegia using tract-based spatial statistics (TBSS) and atlas-based analysis methods. Twenty-two SCI patients (11 cervical SCI and 11 thoracic SCI) and 22 age- and sex-matched healthy controls were included in this study. TBSS and atlas-based analyses were performed between SCI and control groups and between SCI-subgroups using multiple diffusion metrics, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). Compared to controls, SCI patients had decreased FA and increased MD and RD in the corpus callosum (CC; genu and splenium), superior longitudinal fasciculus (SLF), corona radiata (CR), posterior thalamic radiation (PTR), right cingulum (cingulate gyrus; CCG) and right superior fronto-occipital fasciculus (SFOF). Cervical SCI patients had lower FA and higher RD in the left PTR than thoracic SCI patients. Time since injury had a negative correlation with FA within the right SFOF (r = −0.452, p = 0.046) and a positive association between the FA of left PTR and the American Spinal Injury Association (ASIA) sensory score (r = 0.428, p = 0.047). In conclusion, our study suggests that multiple cerebral WM tracts are damaged in SCI patients, and WM disruption in cervical SCI is worse than thoracic injury level, especially in the PTR region.

"Different Types of Inspiratory Muscle Training Provides Betterment in Altered Pulmonary Functions in Upperthoracic Spinal Cord Injuries"

Background:&nbsp;Respiratory problems are usual in upper thoracic spinal cord injuries when compared to Lower thoracic spinal cord injuries. Generally there are frequent respiratory complications in the individuals with spinal cord injuries. The complications of the respiratory system are severe and more prevalent source of morbidity and mortality after the spinal cord injury due to the inefficient breathing capacity including inspiratory and expiratory abilities. The present study represents the inspiratory muscle training especially in upper thoracic spinal cord injury patients to assess the improvement in the pulmonary functions.Methods:&nbsp;Twenty five patients with the age between 25 -40 years with the upper spinal cord injuries were selected in the present study in order to assess the efficacy of the training. Several types of exercises were practiced including diaphragmatic breathing exercises, incentive spirometry, active cycle of breathing technique and weight training. COPD Conditions, Chest wall deformities, Hypertensive patients, Cardio vascular problems were excluded in the study.Results:&nbsp;The results from the study showed that significant changes were found in the patients treated with all the above mentioned techniques. Axillary level, nipple level, Xiphisternum levels were analysed and the results found to be significant after the treatment. Incentive spirometry and peak flow meter observations were also found to be significant when compare to the pretreatment.Conclusion: The present study conclude that the combined effect of incentive spriometry, diaphragmatic breathing exercises, and active cycle of breathing technique is more effective in improving the pulmonary functions in upper thoracic spinal cord injuries than single method efficiency.

Effect of Pranayama (Yogic breathing) on lung function in traumatic thoracic spinal cord injury patients: an interventional study

Background: The incidence of Global Spinal cord injury is 40 to 80 new cases per million populations every year. With low to high levels of spinal cord injury, the respiratory muscles are affected gradually. Lung function worsens up to about 50% to 70%. Total rib cage inflation is not possible. Involvement of the intercostal muscles leads to paradoxical movement which increases the work of breathing. Due to the involvement of the abdominal muscles, the effectiveness of diaphragm and coughing ability are reduced. This leads to respiratory disorders. All this can lead to fatigue and respiratory failure which affects the lung function parameters. Pranayama – a part of YOGA is an art of controlling the life force – the breath. It producesmany systemic and psychophysical effects in the body, besides its specific effects on the respiratory functions. Hence, the present study is designed to assess the shortterm effects of Pranayama on the lung function parameters. Purpose: The purpose of the study was to determine the effect of Pranayama – Yogic breathing on lung function parameters among patients with thoracic spinal cord injury during their hospital stay. Methods: Patients (level D4 to D9) between the age group of 20 to 50 were selected as per the selection criteria. Both male and female having ability to sit were included with written informed consent. Patients were equally divided into two groups Group A and Group B. Patients who were non co-operative and/or with other severe complications, like autonomic dysreflexia, chest trauma and abdominal trauma were excluded. Baseline spirometry tests (FVC, FEV1, FEV1/FVC, PEFR) were performed for both the group at study entry and at completion with and without binder. All patients received their conventional rehabilitation protocol at the institute. Group A received of training of pranayama as form of breathing exercises which comprised of OMCHANTING PRANAYAMA for 3minutes per day, ANULOM VILOM PRANAYAMA for 6minutes and BHRAMARI PRANAYAMA for 3minutes per day. Only group A received this training for 12minutes per session, once in a day for 15 days. Post intervention spirometry parameters same as before were measured. Results: Both the groups demonstrated an increase in all the lung function parameters. Wilcosan sign rank test and Mann–WhitneyU tests apply accordingly. However a significant differencewas observed only in the participants ofGroup A, while changes in lung function parameters in Group B did not reach significance (p< 0.05). Inter group comparison revealed a significant improvement in Group A than Group B (p< 0.05).Within group comparison between pre with binder and post without binder show no significant difference in group A (p< 0.05). Conclusion(s): The study demonstrates that inclusion of pranayama in the rehabilitation of spinal cord injury patients can improve lung function parameters which reduces use of external supportive devises for lung in traumatic thoracic spinal cord injury patients. Implications: Regular practice of Pranayama helps to improve lung function, and became an alternative to aids so it should be included in the rehabilitation program in traumatic spinal cord injury patients with impaired lung functions.

PS5-15 Comparison of lying and standing posture about changing muscle properties in thoracic SCI (spinal cord injury) patients(PS5: Poster Short Presentation V,Poster Session)

PS5-15 Comparison of lying and standing posture about changing muscle properties in thoracic SCI (spinal cord injury) patients(PS5: Poster Short Presentation V,Poster Session)

Increased mean arterial pressure goals after spinal cord injury and functional outcome

Introduction:Acute spinal cord injury (SCI) is often treated with induced hypertension to enhance spinal cord perfusion. The optimal mean arterial pressure (MAP) likely varies between patients. Arbitrary goals are often set, frequently requiring vasopressors to achieve, with no clear evidence supporting this practice. We hypothesize that increased MAP goals and episodes of relative hypotension do not affect hospital outcome.Materials and Methods:All cervical and thoracic SCI patients treated at a level one trauma and regional SCI center over at 2.5-year period were retrospectively reviewed. Lowest and average hourly MAP was recorded for the first 72 h of hospitalization, allowing for quantification of mean MAP and the total number of episodic relative hypotensive events. These data were further compared to daily American spinal injury association motor score (AMS), which was used to determine the severity of SCI and improvement/decline during hospitalization. Patient's data were finally analyzed at theoretic MAP set points.Results:One hundred and five patients had complete data during the study period. At higher theoretic MAP set points (85 and 90), increased number of relative hypotensive episodes correlated with lower admission AMS (85 mmHg: <10 episodes, AMS 66.2; >50 episodes, 22.0; P < 0.001) and the need for vasopressors (P < 0.03) but showed no statistical change in AMS by hospital discharge. The need for vasopressors correlated with the number of hypotensive episodes and inversely related to admission AMS at all theoretic MAP goal set points but was not correlated with the change in AMS during the hospitalization.Conclusions:The frequency of relative hypotension and the need for vasopressors are progressively related to more severe SCI, as denoted by lower admission AMS. However, episodes of hypotension and the need for vasopressors did not affect the change in AMS during the acute hospitalization, regardless of theoretic MAP goal set-point. Arbitrarily elevated MAP goals may not be efficacious.

Video-urodynamic characteristics and management in complete cervical and thoracic spinal cord injury patients

To explore the video-urodynamic characteristics and management in complete cervical and thoracic spinal cord injury patients. Video-urodynamic examination was performed in 113 patients with complete cervical and thoracic spinal cord injury from January 2008 to May 2010. And their characteristics, managements and 3-year follow-up outcomes were reviewed and analyzed retrospectively. Among them, there were detrusor overactivity (n = 82, 72.57%), detrusor areflexia (n = 31, 27.43%), detrusor external sphincter dyssynergia (n = 71, 62.83%), low-compliance (n = 59, 52.21%), reflux (n = 6, 5.31%) and ultrasonic uronephrosis (n = 12, 10.62%). According to the result of the video-urodynamic examination, detrusor overactivity patients chose oral anticholinergic agents, botulinum toxin type A injection method, detrusor areflexia patients chose regular intermittent catheterization for bladder training. During a 3-year follow-up, there were cystic calculus (n = 2) and urinary infection (n = 7).No special complication occurred. The video-urodynamic characteristics vary in complete cervical and thoracic spinal cord injury patients. The major symptoms include detrusor overactivity, detrusor external sphincter dyssynergia and low-compliance bladder. Proper management is essential for protecting upper urinary tract and preventing urinary system complication.

The effects of spinal cord injury on bone healing in patients with femoral fractures

BackgroundOrthopedic literature states that fractures of long bones, when associated with traumatic brain injuries, frequently heal with excessive callus and faster than normal. Few studies, however, have reported these phenomena being induced by spinal cord injury (SCI). Our objective is to compare the extent of callus and the rate of healing of long-bone fractures in patients with or without SCI. Subgroup comparisons were performed among the patients with SCI in terms of different levels of SCI.MethodsThe final mean volume of callus formation and the rate of union of nailed fractures of the femur were determined radiologically in 22 femoral fracture patients with SCI (seven cervical, six thoracic, and nine lumbar spine injury) and compared with those in a group of 22 patients with similar types of fractures but without SCI.ResultsThe final mean callus volume in the fracture/SCI group was significantly higher than the fracture-only group (P < 0.001). The fractures in the fracture/SCI group united in an average time of 22.86 weeks compared with 25.04 weeks in the fracture-only group (P < 0.05). We observed 84.6% (11 of 13) of patients with cervical and thoracic SCI patients with accelerated fracture healing (cervical 6 of 7, thoracic 5 of 6), but only 44.4% (4 of 9) of patients with lumbar SCI appeared to show this phenomenon (P < 0.05).ConclusionsThese results confirm that SCI may be associated with accelerated fracture healing and enhanced callus formation. Furthermore, our study revealed a trend toward enhanced osteogenesis in cervical or thoracic SCI compared with lumbar SCI.

A Hebbian Approach to Retraining Spared Circuits after Spinal Cord Injury (P02.005)

Objective: 1) Characterize spared neural circuitry after spinal cord injury; 2) Determine efficacy of Hebbian exercises targeting neural circuits above the injury level. Background Spinal cord injury (SCI) only rarely causes complete cord transection. Even patients without volitional movement below a lesion often retain some intact circuitry. The fibers most likely to withstand SCI originate in the brainstem, which generally does not mediate conscious movement. To reestablish conscious control over spared circuits, treatments must strengthen connections between brainstem circuits and volitional corticospinal pathways ABOVE the injury. Using a Hebbian approach of 9Fire Together, Wire Together9, we plan to strengthen these connections with exercises that stimulate both cortical and brainstem pathways simultaneously. We have demonstrated the efficacy of this approach in a rodent SCI model (Harel et al., 2010). We now show further preclinical evidence for efficacy, and introduce a clinical study translating this strategy toward human SCI patients. Design/Methods: PRECLINICAL EXPERIMENTS: To extend our previous results, we compared efficacy of dual-mode (brainstem+corticospinal) to single-mode training in a unilateral pyramidotomy model. Multiple behavioral and histological outcomes were assessed. PLANNED CLINICAL STUDY: Chronic thoracic SCI patients are evaluated with a clinical-neurophysiological testing battery including computerized posturography, motor and sensory evoked potentials, and poly-electromyography. Motor-incomplete subjects are randomized into three groups: 1)treadmill training (spinal); 2)balance training (brainstem); or 3)dual-mode training (balance plus corticospinal hand exercises). Primary outcomes: Gait disability; MEP amplitudes at L4 and S1. Results: PRECLINICAL EXPERIMENTS: In mice with unilateral pyramidotomy, dual-mode but not single-mode exercise significantly improved skilled ladder climbing and several principal components of gait kinematics. Histological assessments of CST fiber sprouting will be presented. BASELINE CLINICAL MEASUREMENTS: Initial results of seated computerized posturography, evoked potentials, and poly-electromyography will be presented. Conclusions: Dual-mode exercise rehabilitation targeting cortical and brainstem pathways ABOVE spinal lesions improves outcomes in animal models of SCI. This rehabilitation approach is feasible for application toward human SCI patients. Supported by: NINDS K08NS056212. NINDS R01NS33020. Falk Medical Research Trust. Department of Veterans Affairs RR&D National Center of Excellence for the Medical Consequences of Spinal Cord Injury (#B4162-C). Disclosure: Dr. Harel has received personal compensation for activities with AlphaDetail and Beebe & O9Neil as a consultant. Dr. Song has nothing to disclose. Dr. Tang has nothing to disclose. Dr. Spungen has nothing to disclose. Dr. Strittmatter has received personal compensation for activities with Biogen Idec. Dr. Strittmatter has received royalty payments from Axerion Therapeutics. Dr. Strittmatter holds stock and/or stock options in Axerion Therapeutics. Dr. Strittmatter has received research support from Axerion Therapeutics.

Poster 424: Simultaneously Diagnosed Pulmonary Thromboembolism and Hemopericardium in Thoracic Spinal Cord Injury Patients: A Case Report

Poster 424: Simultaneously Diagnosed Pulmonary Thromboembolism and Hemopericardium in Thoracic Spinal Cord Injury Patients: A Case Report

Traumatic Thoracic ASIA A Examinations and Potential for Clinical Trials

Retrospective review of prospective database. To define the variability of neurologic examination and recovery after nonpenetrating complete thoracic spinal cord injuries (American Spinal Injury Association [ASIA] A). Neurologic examinations after spinal cord injury (SCI) can be difficult and inconsistent. Unlike cervical SCI patients, alterations in thoracic (below T1) complete SCI (ASIA A-based on the ASIA Impairment Scale [AIS]) patients' examinations are based only on sensory testing, thus changes in the neurologic level (NL) are determined only by sensory changes. A retrospective review of the placebo control patients in a multicenter prospective database used for the pharmacologic trial of Sygen. Patients were included if they had a complete thoracic SCI on initial evaluation, with completed ASIA examinations at follow-up weeks 4, 8, 16, 26, and 52. Specifically, pin prick (PP) and light touch (LT) were assessed and the absolute change was calculated as the number of spinal levels at a given observation time. Three thousand one hundred sixty-five patients were initially screened for the Sygen clinical trial, of which 51 were the control placebo patients used in this analysis. Alterations from the baseline examination (PP and LT) were fairly consistent and the median change/recovery in neurologic examination was 1 spinal level. Across all observations postbaseline, the average change for PP was 1.48 +/- 0.13 (mean +/- SE), and for LT, 1.40 +/- 0.13. There were equal proportions of directional changes (none, improved, lost). Changes in a thoracic complete (ASIA A) SCI patients ASIA examination as measured through sensory methods (PP/LT) are fairly uncommon. The overall examination had only 1- to 2-level variability across patients, indicating minimal change in the sensory examination over the follow-up period. Stability in the ASIA examination as measured through sensory methods has thus been demonstrated over time, making it an excellent tool to monitor changes in neurologic function.

Treatment of chronic thoracic spinal cord injury patients with autologous Schwann cell transplantation: An interim report on safety considerations and possible outcomes

Several experimental studies have introduced Schwann cell transplantation as a means of recovery in animal models of spinal cord injury (SCI). The reported promising results together with the availability of autologous sources for Schwann cells indicate Schwann cell transplantation as a possible treatment for SCI. To address the safety and feasibility concerns we report 1-year follow-up of four patients aged between 22 and 43 years who had stable chronic (28-80 months) spinal cord injury at mid-thoracic level and treated with autologous Schwann cell transplantation. Purified Schwann cells used for transplantation were acquired from autologous sural nerve and cultured without the use of any specific mitogenic or growth factors. The patients were evaluated by means of American Spinal Injury Association (ASIA) criteria, sphincter, sexual function and Magnetic Resonance Imaging assessments for 1 year after transplantation. None of the patients were found to have any adverse effects indicating transfer of infection, neurological deterioration or other related clinical problems. Of the four patients, only one patient with incomplete SCI showed motor and sensory improvement 1 year after transplantation with extensive and continuous rehabilitation. All the four patients experienced transient paresthesia or increased muscle spasm after transplantation. Magnetic Resonance (MR) images of the patients did not show any visible changes or pathological findings after 1 year. This preliminary report shows that autologous Schwann cell transplantation is generally safe for the selected number of SCI patients but it does not prove beneficial effects. Further safety and outcome studies are recommended.

Characteristic of diagnosis and treatment of spinal cord stab injury

To investigate the clinical characteristics of the incidence, diagnosis, treatment and prognosis of stab injury of spinal cord. Retrospective study of the clinical materials of 42 stab spinal cord injury patients who were treated in our hospital from 1992 to 2004. Among the patients, 38 were male, and 4 were female. 80% of the cases were thoracic spinal cord injury patients. Incomplete injury cases accounted for 71.4% of all the cases. Of all the 30 incomplete injury cases, 14 had the sign of standard Brown-Sequard syndrome, 6 had the sign of non-standard Brown-Sequard syndrome and 10 do not have the sign of Brown-Sequard syndrome. Magnetic resonance image was very useful to the diagnosis and treatment of the disease. Debridement was a routine to do in acute stage. Operations such as scrutinization of the spinal canal, clean-up of the hematoma, extraction of foreign bodies were optional according to different conditions. After treatment, most of the patients got good recovery as far as ASIA scale and ADL scale were concerned. According to the results above, it is recommended that enough attention should be given to the unique aspects of the disease to effectively facilitate recovery of such cases.

The effect of seat tilting on pelvic position, balance control, and compensatory postural muscle use in paraplegic subjects

Janssen-Potten YJ, Seelen HA, Drukker J, Huson T, Drost MR. The effect of seat tilting on pelvic position, balance control, and compensatory postural muscle use in paraplegic subjects. Arch Phys Med Rehabil 2001;82:1393-402. Objective: To study the effect of seat tilting on pelvic tilt, balance control, and postural muscle use in persons with a thoracic spinal cord injury (SCI). Design: Cross-sectional group study. Setting: Rehabilitation centers and rehabilitation hospital departments. Patients: Ten complete high thoracic SCI (level T2-8) patients, 10 complete low thoracic SCI (level T9-12) patients, and 10 matched able-bodied controls. Intervention: A 10° forward inclination of the seat. Main Outcome Measures: Pelvic tilt, center of pressure displacement, and muscle activity. Results: Anterior tilting of the pelvis as a result of forward inclination of the seat could not be shown, either in persons with or without SCI. Balance control was not influenced by forward inclination of the seat. Participants' overall muscle activity decreased while they were seated in the chair with the forwardly inclined seat. Conclusions: Evidence provided by the kinematic and electromyographic data is not sufficient to develop a protocol for wheelchair prescription on the basis of pelvic positioning. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Chair configuration and balance control in persons with spinal cord injury

Janssen-Potten YJM, Seelen HAM, Drukker J, Reulen JPH. Chair configuration and balance control in persons with spinal cord injury. Arch Phys Med Rehabil 2000;81:401-8. Objective: To study whether chair configuration influences sitting balance in persons with spinal cord injury (SCI). Design: Cross-sectional group study. Setting: Rehabilitation centers and hospital rehabilitation departments. Patients: Ten complete high thoracic SCI (level T2-T8) patients, 10 complete low thoracic SCI (T9-T12) patients, and 10 matched able-bodied controls. SCI participants had completed their active rehabilitation at least 6 months before the study. Interventions: A balance-changing (forward) reaching task while seated in four differently configured chairs. Tilt angle (7° and 12°) and reclination angle (22°) were varied relative to a standard chair configuration (10° reclination). Main Outcome Measures: Maximal unsupported reaching distance, center-of-pressure displacement and muscle activity. Results: Although no significant difference in actively controllable reach was found in controls or in subjects with low SCI, sitting balance improved in all chairs relative to the standard chair. Ability to control displacement of arms and trunk during reaching improved. No apparent need for additional postural muscle activity was found. Persons with high SCI did not improve their sitting balance. They were unable to control a shift in body mass larger than the one induced by arm movement. However, they had less muscle activity after backrest reclination or tilting the chair backwards. Conclusions: The tested chairs had an overall positive effect. However, for individually tailored chair configurations factors other than those investigated should be considered. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Development of new muscle synergies in postural control in spinal cord injured subjects

The development of new patterns of postural control in patients with a complete thoracic spinal cord injury (SCI) during their active clinical rehabilitation was studied. Especially the role of non-postural muscles, like the latissimus dorsi (LD) and the trapezius pars ascendens (TPA), in maintaining and restoring sitting balance during standardized bimanual task performance was investigated. Twelve patients, diagnosed with an acute complete thoracic SCI between spinal cord level T2 and T12, participated in a longitudinal experimental study. Changes in the centre of pressure (CP) and electromyographic activity of the erector spinae (ES) at level L3, T9 and T3, the LD, the TPA, the pectoralis major (PM), the serratus anterior and the oblique abdominal muscles were investigated at several moments in the rehabilitation process. Results show a gradual development of specific muscle activation patterns for both high and low thoracic SCI patients. These patterns seem to be related to a combination of restoration of function of the ES-L3 and ES-T9 in the low thoracic SCI subjects and increased compensatory muscle use of the LD, TPA and PM in high SCI patients. The range in which low thoracic SCI patients can actively vary their CP increased slightly during rehabilitation.

A study of the alpha-1 adrenoceptor blocker prazosin in the prophylactic management of autonomic dysreflexia in high spinal cord injury patients

The ability of the alpha-1 adrenoceptor antagonist, prazosin, to reduce the severity and duration of episodes of autonomic dysreflexia was studied in cervical and high thoracic spinal cord injury patients with documented episodes of autonomic dysreflexia. Sixteen patients participated in a double blind parallel group study comparing prazosin 3 mg b.d. with placebo given for 2 weeks. Both groups were matched for age, sex and baseline severity of autonomic dysreflexia episodes. Prazosin was well tolerated and did not produce a significant lowering of resting blood pressure. Compared to baseline measurements, patients allocated to prazosin therapy were found to have fewer severe episodes of autonomic dysreflexia and during these episodes to have significant reductions in average rise in systolic and diastolic blood pressure, symptom duration and requirement for acute antihypertensive medication. The severity of headache during individual autonomic dysreflexia episodes was also diminished with prazosin therapy. No symptom parameter was significantly altered by placebo therapy. It is concluded that prazosin is superior to placebo in the prophylactic management of autonomic dysreflexia and that these findings are consistent with suggestions that alpha-1 adrenoceptors play an important role in the pathogenesis of this syndrome.