Reactive balance responses to an unexpected slip perturbation in individuals with incomplete spinal cord injury

BackgroundFrequent falls while walking among individuals with incomplete spinal cord injury may suggest impairments in reactive balance control; however, reactive balance control during walking has not been studied in this population. The objective was to compare reactive balance control with respect to changes in margin of stability, onset of arm and heel responses, and onset and magnitude of muscle activity following an unexpected slip perturbation in individuals with incomplete spinal cord injury and able-bodied individuals.MethodsKinematic and electromyography data were obtained during normal walking and one unexpected slip. Changes in margin of stability following a compensatory or aborted step, onset of arms and trail heel responses, and onset and magnitude of activation of the tibialis anterior, soleus and gluteus medius were calculated. Multivariate analyses compared responses between incomplete spinal cord injury and able-bodied groups.FindingsData from 16 participants with incomplete spinal cord injury (all American Spinal Injury Association Impairment Scale Grade D, 8 with tetraplegia) and 13 age-and-sex matched able-bodied individuals were included. Individuals with incomplete spinal cord injury demonstrated limited ability to increase margin of stability in the lateral direction during a compensatory or aborted step, and a smaller magnitude of soleus activity compared to able-bodied individuals.InterpretationThere are limitations in reactive balance control of individuals with incomplete spinal cord injury, which may be a reason for the high frequency of falls in this population. Reactive balance assessment should be included as a component of routine balance assessment and fall avoidance strategies in this population.     

Perturbation-evoked lateral steps in older adults: Why take two steps when one will do?

BackgroundHip fractures in older adults often result from a fall in the lateral direction. While younger adults tend to recover balance from a lateral perturbation with a single lateral sidestep, older adults are prone to multistep responses which are associated with an increased fall risk. This study compared the stepping characteristics and stability of single and multistep responses to lateral perturbation in healthy older adults.MethodsEighty-four older adults received lateral waist-pull perturbations to either side. Spatio-temporal stepping characteristics and balance stability were quantified.FindingsFewer steps were taken to recover balance when the first step was a lateral sidestep. The stability margin of single lateral sidesteps was greater than medial sidesteps and cross-over steps to the back but not significantly different from single cross-over steps to the front at step termination. Single step responses were more stable than multistep responses at step termination and at step initiation for lateral sidesteps and cross-over steps to the front. The decreased stability of multistep responses was attributed to an increased center of mass velocity and a smaller distance between the center of mass and base-of-support at step termination.InterpretationAlthough lateral sidesteps result in fewer steps than cross-over steps to the front, the stability margin was not significantly different at step termination. These results suggest difficulty terminating center of mass motion and/or inefficient center of mass control differentiates single and multistep responses. Future studies should investigate perturbation training and/or hip abductor muscle conditioning as a means of improving compensatory stepping reactions.     

不完全性脊髓损伤患者与健康人步态变异性、对称性和协调性的对照研究

目的：通过观察不完全性脊髓损伤患者的步态变异性、对称性和协调性，更加全面了解脊髓损伤患者的步态特点。方法：选取22例不完全性脊髓损伤患者（观察组）及健康人（对照组），健康人按正常歩速及匹配患者速度行走分为（对照组A）及（对照组B），采用三维运动采集系统及足底压力采集系统进行步态测试。用步态变异值、对称值和相位协调指数表示步态变异性、对称性和协调性，比较3组受试者步态变异性、对称性和协调性的差异及与步行功能相关性。结果：观察组的步长变异值、站立相变异值及迈步相变异值均高于对照组A，观察组的步长对称值、站立相对称值、迈步相对称值和相位协调指数均低于对照组，且差异有统计学意义（P＜0.05）。观察组的步态变异值、对称值和相位协调指数与脊髓损伤步行能力负相关。多元线性回归分析显示站立相变异值、站立相对称值和PCI对WISCI-II步行指数均有显著负影响，PCI对FIM步行指数有显著负相影响。结论：不完全性脊髓损伤患者的步态变异性、对称性和协调性均低于健康人，在为不完全性脊髓损伤患者制定康复训练方案时，应考虑步态变异性、对称性和协调性等指标对步行功能的影响。     

Comparison of the Ferno Scoop Stretcher with the Long Backboard for Spinal Immobilization

Objectives. Spinal immobilization is essential in reducing risk of further spinal injuries in trauma patients. The authors compared the traditional long backboard (LBB) with the Ferno Scoop Stretcher (FSS) (Model 65-EXL). They hypothesized no difference in movement during application andimmobilization between the FSS andthe LBB. Methods. Thirty-one adult subjects had electromagnetic sensors secured over the nasion (forehead) andthe C3 andT12 spinous processes andwere placed in a rigid cervical collar, with movement recorded by a goniometer (a motion analysis system). Subjects were tested on both the FSS andthe LBB. The sagittal flexion, lateral flexion, andaxial rotation were recorded during each of four phases: 1) baseline, 2) application (logroll onto the LBB or placement of the FSS around the patient), 3) secured logroll, and4) lifting. Comfort andperceived security also were assessed on a visual analog scale. Results. There was approximately 6–8 degrees greater motion in the sagittal, lateral, andaxial planes during the application of the LBB compared with the FSS (both p < 0.001). No difference was found during a secured logroll maneuver. The FSS induced more sagittal flexion during the lift than the LBB (p < 0.001). The FSS demonstrated superior comfort andperceived security. Conclusion. The FSS caused significantly less movement on application andincreased comfort levels. Decreased movement using the FSS may reduce the risk of further spinal cord injury.     

Postural control and the influence of the extent of thigh support on dynamic sitting balance among individuals with thoracic spinal cord injury

BackgroundUnsupported sitting balance with reduced thigh support is necessary during several daily living activities among individuals with spinal cord injury. This study proposed to compare dynamic unsupported sitting postural control under reduced thigh support conditions in individuals with motor-complete thoracic spinal cord injury and able-bodied individuals.MethodsThirteen individuals with spinal cord injury and thirteen able-bodied individuals were asked to put on a t-shirt and reach forward while sitting on a force platform using maximum, medium or minimum thigh support extent. Postural control was measured by the center of pressure parameters.FindingsIndividuals with spinal cord injury presented larger postural sway parameters and mean velocity of the center of pressure displacement in anterior-posterior direction during the t-shirt wearing task. On the other hand, these parameters were lower in the medial-lateral direction. These results are more expressive when the task was performed in reduced thigh support conditions [F(1,76) = 5.05–18.70; p < 0.05]. Lower postural sway parameters and mean velocity of the center of pressure displacement in anterior-posterior, and postural sway in medial-lateral direction in the three thigh support conditions were observed when individuals with spinal cord injury performed the forward reaching task [F(1,76) = 9.81–185.46; p < 0.01].InterpretationThe results confirm that individuals with motor-complete thoracic spinal cord injury have poor postural stability and show a trunk postural sway constraint to maintain the suboptimal unsupported sitting balance. Reduced thigh support extent can challenge the dynamic sitting balance in individuals with thoracic spinal cord injury and should be indicated to train new and diversified postural control strategies.     

Robotic resistance treadmill training improves locomotor function in human spinal cord injury: a pilot study

Wu M, Landry JM, Schmit BD, Hornby TG, Yen S-C. Robotic resistance treadmill training improves locomotor function in human spinal cord injury: a pilot study.ObjectiveTo determine whether cable-driven robotic resistance treadmill training can improve locomotor function in humans with incomplete spinal cord injury (SCI).DesignRepeated assessment of the same patients with crossover design.SettingResearch units of rehabilitation hospitals in Chicago.ParticipantsPatients with chronic incomplete SCI (N=10) were recruited to participate in this study.InterventionsSubjects were randomly assigned to 1 of 2 groups. One group received 4 weeks of assistance training followed by 4 weeks of resistance training, while the other group received 4 weeks of resistance training followed by 4 weeks of assistance training. Locomotor training was provided by using a cable-driven robotic locomotor training system, which is highly backdrivable and compliant, allowing patients the freedom to voluntarily move their legs in a natural gait pattern during body weight supported treadmill training (BWSTT), while providing controlled assistance/resistance forces to the leg during the swing phase of gait.Main Outcome MeasuresPrimary outcome measures were evaluated for each participant before training and after 4 and 8 weeks of training. Primary measures were self-selected and fast overground walking velocity and 6-minute walking distance. Secondary measures included clinical assessments of balance, muscle tone, and strength.ResultsA significant improvement in walking speed and balance in humans with SCI was observed after robotic treadmill training using the cable-driven robotic locomotor trainer. There was no significant difference in walking functional gains after resistance versus assistance training, although resistance training was more effective for higher functioning patients.ConclusionsCable-driven robotic resistance training may be used as an adjunct to BWSTT for improving overground walking function in humans with incomplete SCI, particularly for those patients with relatively high function.     

Quantifying muscle coactivation in individuals with incomplete spinal cord injury using wavelets

BackgroundIndividuals with incomplete spinal cord injury often have decreased gait function and coactivation of antagonistic muscle pairs. Common ways of quantifying coactivation using electromyographic signals do not consider frequency information in the signal. As electromyographic signals from different motor unit types have different frequency components and muscle fiber type can change in individuals with spinal cord injury, it may be beneficial to consider frequency components. The aims were to demonstrate the utility of using a method which considers temporal and frequency components of the electromyographical signal to quantify coactivation in lower extremity muscles in individuals with incomplete spinal cord injury through 1) comparison with able-bodied individuals and 2) comparison before and after body weight supported treadmill training.MethodsFrequency decomposition techniques were applied to electromyographical signals to consider the temporal and frequency components of the electromyographical signals to quantify coactivation over a range of frequencies.ResultsOur main findings show that correlation coefficients between total EMG intensities of rectus femoris-biceps femoris and medial gastrocnemius-tibialis anterior were significantly different between able-bodied individuals and those with incomplete spinal cord injury (p = 0006, p = 0.01). The correlation spectra of medial gastrocnemius-tibialis anterior of the spinal cord injury group were substantially different than those the able-bodied group, while the EMG normalcy score was significantly different (p = 0.002). We also found that there was a change in coactivation of ankle muscles after body weight supported treadmill training.InterpretationOur findings indicate that there may be frequency specific differences in muscle coactivation between able-bodied individuals and those with incomplete spinal cord injury. Changes in coactivation were also observed before and after body weight supported treadmill training. These differences may reflect the changes in recruitment patterns of different motor unit types.     

Reliability of daily step activity monitoring in adults with incomplete spinal cord injury

We determined the number of days of step activity monitoring required to establish stable measures of walking activity in adults with incomplete spinal cord injury (iSCI). Eleven individuals with iSCI (mean age 49 +/- 14 years) wore a StepWatch Activity Monitor during waking hours for 7 consecutive days. We used generalizability theory to identify sources of variance in daily step counts and determine the minimum number of days necessary to obtain a reliability coefficient (G-coefficient) greater than or equal to 0.80. Average daily step activity (DSA) was 1,281 +/- 1,594 steps. Participants and days accounted for 70.9% and 1.3% of total variance in DSA, respectively, while unidentifiable error accounted for 27.8% of the total variance in DSA. A minimum of 2 days was required to achieve a G-coefficient greater than or equal to 0.80. An acceptably stable measure of walking activity in adults with iSCI can be obtained by averaging step count values from any 2-day period in a week. Results from this investigation should be useful in evaluating the effect of activity-based programs designed to enhance locomotor function in persons with iSCI.     

Biomechanical analysis of a posterior transfer maneuver on a level surface in individuals with high and low-level spinal cord injuries

OBJECTIVE: The purpose of this study was to determine the movement patterns and the muscular demand during a posterior transfer maneuver on a level surface in individuals with spinal cord injuries. DESIGN: Six participants with high-level spinal cord injury (C7 to T6) were compared to five participants with low-level spinal cord injury (T11 to L2) with partial or complete control of abdominal musculature. BACKGROUND: Developing an optimal level of independence for transfer activities figures among the rehabilitation goals of individuals with spinal cord injury. There has been no biomechanical study which specifically describes the posterior transfer maneuver. METHODS: Tridimensional kinematics at the elbow, shoulder, head and trunk, as well as surface electromyographic data of the biceps, triceps, anterior deltoid, posterior deltoid, pectoralis major, latissimus dorsi, trapezius and rectus abdominus muscles were recorded during the posterior transfer. To quantify the muscular demand, the electromyographic data were amplitude normalized to the peak value obtained from maximum voluntary contractions. The transfer was divided into pre-lift, lift, and post-lift phases for analysis. RESULTS: The duration of the lift phase was significantly shorter (P<0.05) for the high-level spinal cord injury (1.24; SD, 0.37 s) when compared to the low-level spinal cord injury (1.74; SD, 0.39 s). The patterns and magnitudes of the angular displacements were found similar between groups (P values: 0.45-0.98). However, the high-level spinal cord injury initiated the task from a forward flexed posture, whereas the low-level spinal cord injury adopted an almost upright alignment of the trunk. Higher muscular demands were calculated for all muscles among high-level spinal cord injury participants during the transfer when compared to the low-level spinal cord injury. However, only the anterior deltoid (high level=92.4%; low level=34.2%) and the pectoralis major (high level=109.8%; low level=25.6%) reached statistical significance during the lift phase.Conclusions. Participants with high-level spinal cord injury presented different movement characteristics and higher muscular demands during the posterior transfer than low-level spinal cord injury ones. This is probably to compensate for the additional trunk and upper limb musculature impairment. RELEVANCE: The findings of this study may help to develop guidelines of specific strengthening programs for the thoracohumeral, scapulothoracic and shoulder muscles designed to restore optimal transfer capacity in individuals with spinal cord injury. Furthermore, innovative rehabilitation programs targeting the ability to control the trunk could be beneficial for these individuals.     

Gait adaptation during walking on an inclined pathway following spinal cord injury

Background

Individuals with incomplete spinal cord injury need to be assessed in different environments. The objective of this study was to compare lower-limb power generation in subjects with spinal cord injury and healthy subjects while walking on an inclined pathway.

Methods

Eleven subjects with spinal cord injury and eleven healthy subjects walked on an inclined pathway at their natural gait speed and at slow gait speed (healthy subjects only). Ground reaction forces were recorded by force plates embedded in the inclined pathway and a 3-D motion analysis system recorded lower-limb motions. Data analysis included gait cycle parameters and joint peak powers. Differences were identified by student t-tests.

Findings

Gait cycle parameters were lower in spinal cord injury subjects compared to healthy subjects at natural speed but similar at slow gait speed. Subjects with spinal cord injury presented lower power at the ankle, knee and hip compared to healthy subjects at natural gait speed while only the power generation at push-off remained lower when the two groups performed at similar speed.

Interpretation

The most important differences are associated with the fact that individuals with spinal cord injury walk at a slower speed, except for the ankle power generation. This study demonstrated that, even with a good motor recovery, distal deficits remain and may limit the ability to adapt to uphill and downhill walking. Inclined pathways are indicated to train patients with spinal cord injury. Clinicians should focus on the speed of uphill and downhill walking and on the use of plantar flexors.     

Stepping strategies used by post-stroke individuals to maintain margins of stability during walking

BackgroundPeople recovering from a stroke are less stable during walking compared to able-bodied controls. The purpose of this study was to examine whether and how post-stroke individuals adapt their steady-state gait pattern to maintain or increase their margins of stability during walking, and to examine how these strategies differ from strategies employed by able-bodied people.MethodsTen post-stroke individuals and 9 age-matched able-bodied individuals walked on the Computer Assisted Rehabilitation Environment. Medio-lateral translations of the walking surface were imposed to manipulate gait stability. To provoke gait adaptations, a gait adaptability task was used, in which subjects occasionally had to hit a virtual target with their knees. We measured medio-lateral and backward margins of stability, and the associated gait parameters walking speed, step length, step frequency, and step width.FindingsPost-stroke participants showed similar medio-lateral margins of stability as able-bodied people in all conditions. This was accomplished by a larger step width and a relatively high step frequency. Post-stroke participants walked overall slower and decreased walking speed and step length even further in response to both manipulations compared to able-bodied participants, resulting in a tendency towards an overall smaller backward margins of stability, and a significantly smaller backward margin of stability during the gait adaptability task.InterpretationPost-stroke individuals have more difficulties regulating their walking speed, and the underlying parameters step frequency and step length, compared to able-bodied controls. These quantities are important in regulating the size of the backward margin of stability when walking in complex environments.     

Curve walking is not better than straight walking in estimating ambulation-related domains after incomplete spinal cord injury

Labruyère R, van Hedel HJ. Curve walking is not better than straight walking in estimating ambulation-related domains after incomplete spinal cord injury.ObjectivesTo investigate whether a figure-of-8–shaped walking test can estimate various domains of walking in subjects with incomplete spinal cord injury (iSCI) better than the 10-meter walk test (10MWT), and to explore similarities and differences between the 2 tests and between subjects with iSCI and age-matched, healthy controls.DesignCase-control study.SettingSpinal cord injury center of a university hospital.ParticipantsA convenience sample of subjects with iSCI (n=15; mean age, 50y; 40% women; neurologic level from C3 to L5; median time since injury, 5mo) was compared with an age-matched control group (47% women).InterventionsNot applicable.Main Outcome MeasuresThe figure-of-8 test (FET) included 6 conditions to test the subjects' ability to adapt their gait to several circumstances. These conditions covered normal and maximal walking speed, constrained vision, obstacles, foamed soles, and a dual task. Additionally, subjects were tested for lower extremity muscle strength, gait capacity (10MWT) and balance, independence, and fear of falling.Results(1) Preferred straight-walking speed correlated with the different FET conditions in both groups; (2) if normalized to preferred straight-walking speed, FET conditions showed significant differences between both groups; (3) if normalized to preferred curve-walking speed, these differences seemed to disappear; and (4) the 10MWT appeared superior to the different conditions of the FET in estimating various walking-related functions.ConclusionsSubjects with iSCI seem to have difficulties with curve walking compared with straight walking. We therefore recommend the implementation of curve walking into rehabilitation training programs. However, the FET did not provide a better estimate of functional ambulation performance after an iSCI compared with the 10MWT.     

The use of turning tasks in clinical gait analysis for children with cerebral palsy

BackgroundTurning while walking is a crucial component of locomotion that is performed using an outside (step) or inside (spin) limb strategy. The aims of this paper were to determine how children with cerebral palsy perform turning maneuvers and if specific kinematic and kinetic adaptations occur compared to their typically developing peers.MethodsMotion capture data from twenty-two children with cerebral palsy and fifty-four typically developing children were collected during straight and 90° turning gait trials. Experimental data were used to compute spatio-temporal parameters, margin of stability, ground reaction force impulse, as well as joint kinematics and kinetics.FindingsBoth child groups preferred turning using the spin strategy. The group of children with cerebral palsy exhibited the following adaptations during turning gait compared to the typically developing group: stride length was decreased across all phases of the turn with largest effect size for the depart phase (2.02), stride width was reduced during the turn phase, but with a smaller effect size (0.71), and the average margin of stability during the approach phase of turning was reduced (effect size of 0.98). Few overall group differences were found for joint kinematic and kinetic measures; however, in many cases, the intra-subject differences between straight walking and turning gait were larger for the majority of children with cerebral palsy than for the typically developing children.InterpretationIn children with cerebral palsy, turning gait may be a better discriminant of pathology than straight walking and could be used to improve the management of gait abnormalities.     

miR-338-5p Levels and Cigarette Smoking are Associated With Neuropathic Pain Severity in Individuals With Spinal Cord Injury: Preliminary Findings From a Genome-Wide microRNA Expression Profiling Screen

ObjectiveTo identify microRNA biomarkers and clinical factors associated with neuropathic pain after spinal cord injury.DesignCross-sectional, secondary analysis of baseline data collected from ongoing clinical studies. Using a genome-wide microRNA screening approach, we studied differential microRNA expression in serum from 43 adults with spinal cord injury enrolled in ongoing clinical studies. Least squares regression was used to identify associations between microRNA expression, clinical factors, and neuropathic pain severity.SettingCommunity-dwelling individuals with spinal cord injury.ParticipantsParticipants (N=43) were at least 18 years old with spinal cord injury, with 28 reporting neuropathic pain and 15 reporting no neuropathic pain.InterventionsNot applicable.Main Outcome MeasuresPain presence, type, and intensity were assessed with the International Spinal Cord Injury Pain Basic Data Set. Serum microRNA normalized deep sequencing counts were quantified from blood samples. Participant demographic factors, injury characteristics, medication use, and health habits were collected via questionnaire.ResultsmiR-338-5p expression and history of cigarette smoking were associated with and explained 37% of the variance in neuropathic pain severity (R²=0.37, F_2,18=5.31, P=.02) independent of other clinical factors. No association was identified between miR-338-5p levels and nociceptive pain severity.ConclusionsOur findings suggest that miR-338-5p and cigarette smoking may both play a role in the development or maintenance of neuropathic pain after spinal cord injury. While additional work is needed to confirm these findings, validated target analysis suggests a neuroprotective role of miR-338-5p in modulating neuroinflammation and neuronal apoptosis and that its downregulation may result in maladaptive neuroplastic mechanisms contributing to neuropathic pain after spinal cord injury.     

斜床站立治疗颈髓损伤后体位性低血压的临床观察

目的 观察斜床站立对颈髓损伤后体位性低血压的治疗作用。方法 将36例颈髓损伤患者随机分为斜床组和常规组，在康复治疗过程中每日监测卧立位血压，治疗前后评定脊髓功能。结果 两组治疗后感觉及运动功能均有显著改善，但两组治疗后脊髓功能评分无统计学差异。36例颈髓损伤患者有27例（75％）出现体位性低血压，其中完全性脊髓损伤患者均出现体位性低血压。治疗后完全性脊髓损伤所致的体位性低血压两组均无明显改善，不完全性脊髓损伤斜床组血压均较治疗前显著改善，卧立位血压差值减少（P＜0．05）。与常规组相比较，斜床组治疗后血压改善（P＜0．05）。结论 颈髓损伤可出现体位性低血压，其中完全性颈髓损伤均不同程度出现体位性低血压。斜床站立可改善不完全性脊髓损伤民致的体位性低血压。     

Establishing the NeuroRecovery Network Community Fitness and Wellness facilities: multi-site fitness facilities provide activity-based interventions and assessments for evidence-based functional gains in neurologic disorders

Abstract

Background: Physical fitness is a necessity for those living with a spinal cord injury, yet access to fitness facilities, equipment, and specially trained fitness experts are limited.

Methods: This article introduces the concept of a network of fitness facilities specially geared towards individuals with spinal cord injury and other neurological disorders.

Results: The Community Fitness and Wellness branch of the NeuroRecovery Network was created to provide a continuum of care after traditional rehabilitation for individuals living with a spinal cord injury and other neurological disorders. Community Fitness and Wellness facilities translate activity-based interventions performed during rehabilitation into a community setting as well as provide other fitness and wellness opportunities. Community Fitness and Wellness facilities are staffed by professionals with training on the specialized needs of individuals living with spinal cord injury or other neurological disorders. Standardized assessments evaluate functional, health, and quality of life gains at regular intervals. A national database gathers information on standardized interventions and assessment outcomes providing a mechanism for evaluation of interventions performed in the community setting.

Conclusions: The establishment of Community Fitness and Wellness facilities allows for the quick translation and evaluation of novel, effective approaches from research to individuals in the community.

• Implications for Rehabilitation

• Fitness needs of individuals with spinal cord injury living in the community necessitate the use of special equipment and trained staff.

• Community Fitness and Wellness Programs offer specially trained staff and adaptive equipment providing a continuity of care for those with spinal cord injuries and other neurological disorders.

     

Step Activity Monitor: accuracy and test-retest reliability in persons with incomplete spinal cord injury

Recovery of walking after incomplete spinal cord injury (iSCI) is a common focus of rehabilitation, but few measurement tools capture walking performance outside the clinic or laboratory. This study determined the accuracy and test-retest reliability of the Step Activity Monitor (SAM), a microprocessor-driven accelerometer that measures walking activity. We evaluated 11 individuals with iSCI during replicate 6-minute walk tests (6MWTs) and 10-meter walk tests (10mWTs) scheduled <1 week apart. The SAM was 97% accurate compared with hand-tallied step counts. SAM values were stable across repeated walking performances (intraclass correlation coefficient = 0.97-0.99). Standard error of measurement values were 6.0 steps and 0.8 steps for the 6MWT and 10mWT, respectively. Ninety-five percent confidence intervals were 203.7 to 177.0 steps for the 6MWT and 16.1 to 12.7 steps for the 10mWT. The SAM is an accurate and reliable device for capturing walking activity in individuals with iSCI.     

“My body was my temple”: a narrative revealing body image experiences following treatment of a spinal cord injury

Purpose: This narrative explores the lived experience of a young woman, Rebecca, and her transitioned body image after sustaining and being treated for a spinal cord injury.

Method: Data were collected from a single semi-structured in-depth interview.

Results: Rebecca disclosed her transitioned body image experiences after sustaining a spinal cord injury and being treated by medical staff immediately following her injury. Before her injury, she described a holistic body experience and named this experience her “temple”. During intensive care in the hospital, she explained her body was treated as an object. The disconnected treatment of her body led to a loss of the private self, as she described her sacred body being stripped away – her “temple” lost and in ruins.

Conclusions: Body image may be an overlooked component of health following a spinal cord injury. This narrative emphasizes the importance of unveiling body image experiences after the treatment of a spinal cord injury to medical professionals. Lessons of the importance of considering the transitioned body experiences after a spinal cord injury may help prevent body-related depression and other subsequent health impacts. Recommendations for best practice are provided.

• Implications for Rehabilitation

• Spinal Cord Injury

• ??A spinal cord injury may drastically change a person’s body image, thereby significantly impacting psychological health

• ??More effective screening for body image within the medical/rehabilitation context is needed to help practitioners recognize distress

• ??Practitioners should be prepared to refer clients to distress hotlines they may need once released from treatment

     

Differential effects of sustained inflation recruitment maneuvers on alveolar epithelial and lung endothelial injury

OBJECTIVE: The role of recruitment maneuvers in mechanical ventilation for patients with the acute respiratory distress syndrome and acute lung injury remains uncertain in part due to a lack of data on the effects of specific recruitment maneuvers on lung injury severity. The primary objective of this study was to determine the effect of one type of recruitment maneuver--sustained inflation--on alveolar epithelial and lung endothelial injury in experimental acute lung injury. DESIGN: Randomized experimental study. SETTING: Academic research laboratory. SUBJECTS: Forty-nine Sprague-Dawley rats. INTERVENTIONS: Lung injury was induced in anesthetized, ventilated rats by instillation of acid (pH 1.5) into the airspaces. Rats were ventilated with a tidal volume of 6 mL/kg and a positive end-expiratory pressure of 5 cm H(2)O with or without a sustained inflation recruitment maneuver repeated every 30 mins. Each recruitment maneuver consisted of two 30-sec inflations to total lung capacity (30 cm H(2)O) 1 min apart. MEASUREMENTS AND MAIN RESULTS: The use of recruitment maneuvers significantly improved oxygenation, compliance, end-expiratory lung volume, functional residual capacity, and deadspace fraction. Recruitment maneuvers reduced extravascular lung water and lung endothelial injury as measured by protein permeability (217 +/- 28 vs. 314 +/- 70 extravascular plasma equivalents [microL], p < .05). However, recruitment maneuvers did not prevent alveolar epithelial injury. Epithelial permeability and bronchoalveolar lavage RTI40 levels, a marker of type I cell injury, were similar with or without recruitment maneuvers. Recruitment maneuvers decreased epithelial fluid transport, a functional marker of epithelial injury. Recruitment maneuvers did not reduce markers of airspace inflammation. CONCLUSIONS: Sustained inflation recruitment maneuvers improve respiratory mechanics and oxygenation and may protect the lung endothelium but do not reduce alveolar epithelial injury. Because of the differential effects of recruitment maneuvers on the lung endothelium and alveolar epithelium, the net effect in clinical acute lung injury may not be beneficial. Additional clinical studies will be needed to assess the net impact of recruitment maneuvers in patients with acute lung injury.     

The effect of rhythmic auditory stimulation on the gait parameters of patients with incomplete spinal cord injury: an exploratory pilot study

This exploratory pilot study examined the immediate entrainment effects of rhythmic auditory stimulation on the gait parameters of cadence, velocity, and stride length in patients with incomplete spinal cord injury. Seventeen patients with incomplete spinal cord injury, mean age of 41 years and on average 5.88 years postinjury, participated in a within-subjects repeated measures design with counterbalanced conditions. Participants completed four, 10-meter walks: walk 1, participants walked at their normal pace without rhythm; walk 2, participants walked to a rhythm set to the tempo of their uncued normal walk; walk 3, participants walked as fast as safely possible, without auditory rhythm; and walk 4, participants walked to an auditory rhythm set 5% higher than their uncued fast walk. Mean scores for cadence and velocity decreased with rhythmic cueing at the normal tempo, whereas average stride length increased. On average, all parameters decreased at the fast tempo. No changes were statistically significant and no interaction emerged between cueing and tempo for any gait parameter. Despite the lack of effects, many participants were able to entrain with rhythm at the normal tempo, as evidenced by small improvements in cadence and velocity. Patient response to rhythmic cueing may differ according to age and level of injury. Younger participants were more likely to increase velocity and stride length at the fast tempo (P=0.025). At the normal tempo, patients with cervical injuries tended to increase cadence, whereas patients with thoracic injuries showed improvements in stride length and velocity.