Rehabilitation in spinal cord injury

Caring for the new quadriplegic is an immense undertaking involving multiple health care professionals who must function as a team. The physician in charge must understand rehabilitation principles and be able to communicate with all members of the team caring for the patient. Rehabilitation principles, if considered early, can greatly decrease the length of stay of the patient and allow him to maximize his potential for recovery. A basic knowledge of physicial and occupational therapy in paraplegia and quadriplegia in the acute stage as well as functional expectations in the long term have been presented.     

Pediatric spinal cord injury

Although the incidence of spinal cord injury in childhood is lower than in adults, the impact is significant when the number of years with resulting severe limitations are considered. Prevention is the key to spinal cord management in all age groups, but takes on a stronger, more emphasized sense of urgency with children. If methods of prevention fail, successful early management of a child with spinal cord injury is the best hope for a future filled with accomplishments.     

Functional paralysis mimicking spinal cord injury resulting in admission to a spinal cord injury center

From 1978 through 1982, five patients with final diagnoses of nonorganic functional paraplegia or quadriplegia were seen and treated at the Northern California Regional Spinal Cord Injury Center. The patients ranged in age from 13 to 26 years and four were males. All had normal bowel and bladder function with otherwise complete motor and sensory paralysis, shifting sensory findings, and normal deep tendon reflexes early after injury. In each patient, a retrospective analysis demonstrated that structural anatomic lesion could be ruled out by a neurologic examination. Clinical and investigatory studies are discussed with respect to the diagnostic process.     

Secondary spinal lesions in spinal cord injury patients

On hospital admission, 6 spinal cord injured patients were noted to have second noncontiguous levels of spinal injury that were previously unrecognized. These secondary levels of spinal injury were diagnosed as a result of routine admission total spine radiographic examinations. Two cases are described in detail, one with the secondary spinal lesion above and the other below the primary spinal cord injury. Careful total spine radiographic studies are recommended to prevent complications, in the event that such lesions are initially unrecognized.     

持续性脊髓压迫对脊髓损伤程度的影响

目的 探讨脊髓损伤(SCI)后脊髓压迫时间对损伤程度的影响。方法 以大脑皮层诱发电位(CSEP)和不同压迫时间为参数,自行设计一种犬的运动—静止压迫型SCI模型,选择T13为损伤中心,压迫脊髓,当 CSEP波幅下降达基础值的 50%时,维持静止压迫。将28只犬随机分为A、B、C、D 4组,A、B、C组脊髓分别受压30 min、90 min和180 min,D组为对照组,观察各组动物的组织病理学、影像学和行为学变化。结果 损伤组脊髓组织学均有损害,MRI显示损害程度随脊髓受压时间的延长逐渐加重( P<0.01);至术后28 d,各损伤组动物后肢功能均有恢复,BBB分级评分法评估组间有显著性差异( P <0.05)。结论 SCI后持续性脊髓压迫能加重损伤程度,应尽早解除脊髓压迫。     

Body composition in spinal cord injury

A study of body composition was conducted on 45 patients with spinal cord injury (SCI) and 12 able-bodied healthy subjects who served as controls. Body composition was assessed in terms of water (W), fat (F), protein (P), and mineral (M) content. SCI patients exhibited lower absolute amounts of W, F, and P, but no differences in the the amounts of these components when expressed relative (percentage) to gross body weight (BW). As estimated in this study, the amount of bone mass constituted a higher percentage of the gross BW. This suggests that, although SCI patients lose calcium in the early stages of the disease, the loss of weight that follows SCI is principally due to the loss of W, F, and P.     

Bladder trabeculation in spinal cord injury

Bladder trabeculation may occur as an early manifestation of neurogenic bladder following spinal cord injury. The prevalence of bladder trabeculation in relation to other urologic morbidity was assessed in this clinical study using a urologic flow sheet. Data were extracted from a retrospective chart review of 90 patients with spinal cord injury (71% men) regularly followed at a tertiary care center. The study population had a mean age of 33.4 +/- 3.4 years and a mean injury duration of 5.5 +/- 3.7 years. Bladder trabeculation was found in 57% overall and in 31% of patients within 12 months of injury and was significantly associated with male sex, vesicoureteral reflux (p = 0.05), bladder diverticulum, and upper motor neuron type of neurogenic bladder (p = 0.01). Comparing systems of drainage, trabeculation was significantly associated with intermittent catheterization and an external collecting device or an external collecting device alone (p = 0.01). Elevated intracystic pressure in trabeculation development in the neurogenic bladder is related to any combination of bladder overdistention, outflow obstruction, and uninhibited detrusor contractions.     

Neurotransmitters in spinal cord injury.

The authors report the distribution of acetylcholinesterase activity and catecholamine fluorescence in the intact and completely transected rat spinal cord. The catecholamine terminals were scarce in the posterior horn and abundant in the intermediale and anterior horn regions. In the thoracic region, intense amine fluorescence was seen in the intermediolateral cell column. Spinal transection resulted in the enhancement of fluorescence above the lesion and disappearance below the lesion within seven days. The cholinesterase activity in the controls was found mostly in the anterior horn region and the tip of the posterior horn. Following transection, there was no significant change in the distribution of this enzyme. These changes correlated with the appearance of spasticity.     

Dynamometry testing in spinal cord injury

Persons with a spinal cord injury (SCI) demonstrate strength deficits that can limit their functional ability to perform activities of daily living. For a specific lesion level, performance of functional activities is related to the level of muscle strength. Consequently, in clinical practice, we need reliable measures of muscle strength to determine mobility and self-care ability. Muscle-strength testing is used to document recovery or loss of motor function early in SCI, as well as measure improvements in strength in chronic SCI. We also need such measures for research purposes to determine the efficacy of clinical trials. Several methods are available for testing muscle strength of persons with SCI, such as handheld, handgrip, and isokinetic dynamometers. This article provides an overview of muscle-contraction definitions and testing methodologies and discusses the reliability of these testing methods and dynamometry devices.     

Drug absorption in spinal cord injury

The absorption characteristics of drugs in spinal cord injury (SCI) were studied using an actively transported drug [riboflavin (RBF)] and a passively absorbed drug [acetaminophen (ACE)]. RBF absorption was studied following oral administration of 150mg RBF as 5'-phosphate flavin mononucleotide in ten clinically complete quadriplegic patients (C1 to C7, two to 15 months post-onset) and six control subjects matched for age, sex, and weight. Urinary excretion was measured under fasting (F) and nonfasting (NF) conditions for time to peak, peak excretion rate, and percent dose recovered. The results showed a significant difference (p less than 0.05) for all parameters between F and NF conditions for both the SCI and able-bodied groups. However, there was no significant difference for the same parameters between the two groups. ACE absorption was studied in five SCI clinically complete quadriplegic patients (C1 to C7, two to 15 months post-onset following the administration of a 650mg tablet. Serum samples were analyzed for ACE content and showed: time of peak, 1.35 +/- 0.6hr; maximum serum level, 6.8 +/- 2.68 micrograms/ml; half-life, 2.89 +/- 1.81hr; absorption lag time, 18.1 +/- 1.8min; area under the serum level-time curve, 21.8 +/- 6.7 micrograms/.hr/ml. When compared to able-bodied population data in the literature, there was a significant increase in the time to peak and lag time, and a decrease in the maximum ACE serum concentration obtained.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pseudomembranous colitis in spinal cord injury

Pseudomembranous colitis is a well-known disease associated with antibiotic administration and caused by the Clostridium difficile toxin. Clinical presentation is usually marked by watery diarrhea, crampy abdominal pain, and fever. Since early appropriate therapy can reduce morbidity and mortality, it is important for health care professionals to be aware of this disease. Patients with spinal cord injury have a relatively high incidence of respiratory and urinary tract infections that are treated with antibiotics. Therefore, these patients theoretically have a higher risk of contracting pseudomembranous colitis. This article presents a case report of a spinal cord injured patient with this disease who has several of the common difficulties encountered in the diagnosis and treatment, such as indeterminate assays and relapses. The clinical presentation, diagnosis, and treatment of pseudomembranous colitis are described.