Sigmoid Colon Rupture Secondary to Crede’s Method in a Patient with Spinal Cord Injury

Abstract

Crede’s method is a manual suprapubic pressure exerted with a clenched fist or fingers, used to initiate micturition, in patients with spinal cord injury (SCI) who have neurovesical dysfunction. It is usually a benign maneuver unassociated with any major complications. This paper will illustrate a case report involving a sigmoid colon rupture secondary to Crede’s method in a patient with SCI. Various techniques of Crede’s method are briefly described. It is recommended that patients with quadriplegia avoid forceful use of Crede’s method, as it may cause contusion of the abdominal wall and injuries to internal viscera, possibly leading to colonic rupture. It is believed that this is the first reported case of such an unusual complication of Crede’s method in patients with SCI.     

Scheuermann’s Kyphosis: a 39-year follow-up from diagnosis in non-operated patients

European Spine Journal - To investigate the impact of Scheuermann’s Kyphosis (SK) on health -related quality of life (HRQOL) in adult patients and compare it to the general population....     

Stem Cell–Based Therapies for Spinal Cord Injury

Summary: Spinal cord injury (SCI) results in loss of nervous tissue and consequently loss of motor and sensory function. There is no treatment available that restores the injury-induced loss of function to a degree that an independent life can be guaranteed. Transplantation of stem cells or progenitors may support spinal cord repair. Stem cells are characterized by self-renewal and their ability to become any cell in an organism. Promising results have been obtained in experimental models of SCI. Stem cells can be directed to differentiate into neurons or glia in vitro, which can be used for replacement of neural cells lost after SCI. Neuroprotective and axon regeneration-promoting effects have also been credited to transplanted stem cells. There are still issues related to stem cell transplantation that need to be resolved, including ethical concerns. This paper reviews the current status of stem cell application for spinal cord repair.     

It’s All of the Above: Benefits of Working for Individuals with Spinal Cord Injury

Background:

The majority of research on employment among persons with spinal cord injury (SCI) focuses on the employment rate at a given point in time to the exclusion of quality employment outcomes.

Objective:

To identify the employment outcomes of greatest importance as defined by those with SCI who have worked since injury.

Methods:

A qualitative approach was used with 6 focus groups at 2 sites (Minnesota and Georgia). Participants (N = 44) were a minimum of 10 years after injury and had been employed at some point after SCI. We identified participants through a 40-year longitudinal study of SCI and a community resource. A combination of homogeneous (race/ethnic minority group, female group) and heterogeneous groups were convened. A semi-structured interview format queried participants about personal, environmental, and policy-related factors that impacted obtaining, maintaining, and advancing in employment.

Results:

Seven overlapping themes were identified under the 2 broad categories of compensation and subjective well-being: (1) salary and what it can support, (2) health insurance and other fringe benefits, (3) promotions and recognition, (4) social connection and support, (5) job satisfaction and enjoyment from working, (6) making a difference and helping others, and (7) psychological and emotional health.

Conclusion:

The results indicate several common themes among persons with SCI who have successful employment histories, suggesting that the benefits of employment are multifaceted and go beyond monetary compensation.     

Spinal Cord Injury and Snowboarding—the British Columbia Experience

Abstract

Snowboarding is an alpine sport growing in popularity, particularly among male youth. This study of 10 consecutive cases admitted to the Vancouver Hospital and Health Sciences Centre Acute Spinal Cord Injury Unit, over the 1997 to 1998 winter season, analyzes the epidemiology of snowboarding spinal injury. Information was collected retrospectively on the mechanism, location, and pattern of injury, and personal details of the individuals who suffered the injuries. The average age at time of injury was 22.4 years, with a range of 16 to 29. All but 1 of the cases were self-acknowledged expert-level snowboarders, with an average of 6.25 years experience. Nine of the injured were male. There was only 1 cervical injury, with the majority being low thoracolumbar, and 4 incidences of L-1 fracture. Compression and burst fracture were the predominant vertebral fracture patterns and there was a 50% incidence of significant neurologic injury and deficit. The most common mechanism of injury was axial loading following a failed jump or fall from a height, varying from 2 to 25 feet. The lack of associated injuries in 9 of the cases suggests a limited ability of the extremities to offset such falls. Contributing factors included the inherent riskiness of the sport, participant characteristics, lack of formal instruction, and self-constructed jumps. Poor weather conditions, unfamiliarity with a run, collisions, and consumption of alcohol also played lesser roles. The frequent association between spinal fracture and significant neurologic deficit in this group has not previously been reported in other studies.     

Spinal Cord Injury Providers’ Perceptions Of Barriers To Implementing Selected Clinical Practice Guideline Recommendations

Abstract

Background/Objective: Twelve focus groups were conducted at 6 Department of Veterans Affairs (DVA) Spinal Cord Injury (SCI) Centers. The purpose of these focus groups was to identify provider-perceived barriers to implementing selected recommendations of two clinical practice guidelines (CPGs)-Prevention of Thromboembolism in Spinal Cord Injury and Management of Neurogenic Bowel in Adults With Spinal Cord Injury-at their sites.

Methods: A total of 75 SCI direct-care staff (including physicians, nurses, dieticians, rehabilitation therapists, psychologists, and social workers) participated in the focus groups, which were conducted by trained focus group facilitators. Woolfs framework was used to classify perceived barriers into 1 of 4 categories: (a) lack of knowledge, (b) lack of agreement, (c) lack of ability, or (d) lack of systematic reminders for implementation. The "lack of ability" category was further expanded to reflect which specific aspect of the environment was seen as the obstacle: (a) patient, (b) provider, (c) SCI unit, (d) hospital or medical center, or (e) non-Veterans Affairs (VA) hospital setting.

Results: Providers disagreed with the recommendation to reinstitute prophylaxis in patients with nona cute SCI to prevent deep vein thrombosis and identified a number of system-level problems with providing appropriate prophylaxis. Providers identified patient reluctance to changing their bowel programs and difficulties in documenting changes in the patients' bowel program as obstacles to implementing the neurogenic bowel CPG.

Conclusion: Based on this feedback, interventions were developed to address provider-perceived barriers. These interventions were implemented at 6 Veterans Affairs SCI Centers.

J Spinal Cord Med. 2003;26:48-58     

Abstracts from the Spinal Cord Research Foundation’s 20th Anniversary Symposium

Abstract

Background: Skeletal muscle atrophy is a common adaptation after spinal cord injury (SCI) that results in numerous health-related complications. Neuromuscular electrical stimulation (NMES) has been recognized as an effective tool, which attenuates atrophy and evokes hypertrophy.

Objective: To investigate the effects of NMES resistance training (RT) on individual muscle groups and adipose tissue of the right thigh after stimulation of the knee extensor muscle group in a man with chronic SCI.

Participant: A 22-year-old man with a complete SCI sustained in a motorcycle accident 5 years prior to participation in this study.

Methods: The participant underwent training twice a week for 12 weeks, including unilateral progressive RT of the right knee extensor muscle group using NMES and ankle weights. The stimulation was applied to knee extensors while the participant was sitting in his wheelchair. A series of T1 -weighted magnetic resonance images were acquired for the whole right thigh prior to and after training. Skeletal muscle cross- sectional areas were measured of the whole thigh, knee extensors, hip adductors, hamstrings, and sartorius and gracilis muscle groups. Additionally, intramuscular fat and subcutaneous fat of the thigh were measured.

Results: At the end of 12 weeks, the participant was able to lift 17 lbs during full knee extension. Average skeletal muscle cross-sectional areas increased in all of the measured muscle groups (12%-43%). Hypertrophy ranging from 30% to 112% was detected in multiaxial slices after the NMES RT protocol. Intramuscular fat decreased by more than 50% and subcutaneous fat increased by 24%.

Conclusion: Unilateral NMES RT protocol evoked hypertrophy in the knee extensor and adjacent skeletal muscle groups and was associated with a reduction in intramuscular fat in a person with a chronic SCI. Additionally, subcutaneous adipose tissue cross-sectional areas increased in response to RT.     

Colonic Transit Time After Spinal Cord Injury: Any Clinical Significance?

Abstract

Background: Both bowel dysfunction and increases in colonic transit time (CTT) are frequently observed in individuals with spinal cord injury; however, it is unknown whether there is an association between chronic intestinal problems and changes in CTTs. The current study investigates a possible relationship between the main intestinal symptoms of SCI patients and CTT values.

Methods: The following clinical variables and symptoms were investigated and collected in 30 individuals with SCI: total time for bowel care, abdominal pain, abdominal gas, success of rectal emptying, fecal incontinence, and decrease in quality of life. Total and segmental CTTs (right colon, left colon, and rectosigmoid colon) were assessed using radiopaque markers. The effects of the sociodemographic variables and the clinical symptoms on the different CTTs (total and segmental) were analyzed.

Results: The assessed clinical conditions were observed in the following percentages of subjects: abdominal gas symptoms (70%), fecal incontinence (56%), abdominal pain (63%), total time for bowel care > 1 hour (11%), difficult rectal emptying (66%), and decrease in quality of life (36%). We also observed an increase in total CTT in 47% of subjects; increases in segmental CTT were found in the right colon in 23%, in the left colon (60%), and in the rectosigmoid segment (23%). Statistical analyses failed to show a significant difference in mean CTT values between the group of symptomatic patients (1 or more symptoms) and the group of asymptomatic patients. No significant difference could be detected in the incidence of each intestinal symptom between the group of participants with normal CTT values and those with abnormal CTT values. For each of the clinical data assessed separately, a significantly longer CTT (left colon) was associated with the lack of abdominal pain (P < .03) and the presence of fecal incontinence (P < .01 ); successful rectal emptying was associated with significantly shorter total (P < .02) and segmental CTTs for the left colon (P < .01 J and rectosigmoid colon (P < .05).

Conclusions: Besides an association between shorter CTT and successful rectal emptying, there was little relationship between CTTs and intestinal symptoms in this study of patients with SCI.     

Spinal Cord Injury: What is the Effect on Sexual Response?

ABSTRACT

In this paper the sexual response cycle and neurologic pathways involved in sexual functioning are reviewed. This is used as a foundation to review the spinal cord injury literature and examine what is primarily self-reported regarding sexual function with varying types of spinal cord injury. A recommendation is made for more thorough, objective studies through which hypotheses can be tested and a foundation built for prognostication of how sexual functioning will be altered after varying types of SCI. (J Am Paraplegia Soc 1991; 14: 40–43)     

Comparison Of Parenting Styles Of Persons With And Without Spinal Cord Injury And Their Children’s Social Competence And Behavior Problems

Abstract

Objective: This study compared the parenting styles of 62 individuals with spinal cord injury (SCI) and 62 individuals without disabilities and the behavior of their children aged 6 through 13 years.

Methods: The relationship between parenting style and children’s behavior was assessed. Pairs were matched by gender of parent and age and gender of child. The Parenting Dimensions Inventory and the Child Behavior Checklist were administered via telephone.

Results: After controlling for income, the 2 groups did not differ in the parenting factors of warmth/structure and strictness. Their children did not differ in social competence or behavior problems.

Conclusion: Regardless of disability status, warmth and structure were found to be the aspects of parenting that were related to children’s outcomes.     

Scheuermann’s kyphosis: surgical management

Indications for surgery in Scheuermann disease are not well codified and remain rare, as the natural history of the disease is in most cases benign. In the immature adolescent, conservative treatment, such as bracing or casting, can be tried for moderate curves. For larger curves, or in the adult, conservative treatment is usually not effective, and surgery can be considered. Such indications are mostly cosmetic for large curves above 75°. Pain over the deformity or in the low back may represent another surgical indication, especially in the adult group. The question of anterior release or straight posterior fusion has become more of an actuality with the advent of powerful, third-generation stiff segmental instrumentation. However, the long-term results of a modern, posterior-only instrumentation fusion are not known. Concern about loss of correction, late pseudarthrosis or the need to remove instrumentation for infected hardware or due to late pain at the operative site must make us careful about choosing this method. Very rigid and large curves still require an anterior release, either done in a conventional or mini-open fashion, or through video-assisted thoracoscopic surgery. The extent of the posterior instrumentation has now been better defined. One must fuse the whole Cobb angle without hypercorrection and stop distally, above the first lordotic disc, to avoid sagittal decompensation. New approaches such as short anterior fusion with bone-on-bone techniques and pedicle substraction osteotomies have not yet been reported in the literature as having been used for treating Scheuermanns kyphosis. These should be considered experimental.     

Effects of Aloe Vera on Spinal Cord Ischemia–Reperfusion Injury of Rats

Aim: The purpose of this study was to evaluate the possible protective/therapeutic effects of aloe vera (AV) on ischemia–reperfusion injury (I/R) of spinal cord in rats. Materials and Methods: A total of 28 Wistar Albino rats were divided into four random groups of equal number (n = 7). Group I (control) had no medication or surgery; Group II underwent spinal cord ischemia and was given no medication; Group III was administered AV by gastric gavage for 30 days as pre-treatment; Group IV was administered single dose intraperitoneal methylprednisolone (MP) after the ischemia. Nuclear respiratory factor-1 (NRF1), malondialdehyde (MDA) and superoxide dismutase (SOD) levels were evaluated. Tissue samples were examined histopathologically and neuronal nitric oxide synthase (nNOS) and nuclear factor-kappa B (NF-κB) protein expressions were assessed by immunohistochemical staining. Results: NRF1 and SOD levels of ischemia group were found to be lower compared to the other groups. MDA levels significantly increased after I/R. Treatment with AV and MP resulted in reduced MDA levels and also alleviated hemorrhage, edema, inflammatory cell migration and neurons were partially protected from ischemic injury. When AV treatment was compared with MP, there was no statistical difference between them in terms of reduction of neuronal damage. I/R injury increased NF-κB and nNOS expressions. AV and MP treatments decreased NF-κB and nNOS expressions.Conclusions: It was observed that aloe vera attenuated neuronal damage histopathologically and biochemically as pretreatment. Further studies may provide more evidence to determine the additional role of aloe vera in spinal cord ischemia reperfusion injury.