Psychosocial outcomes among youth with spinal cord injury by neurological impairment

Objective

Examine psychosocial outcomes of youth with spinal cord injury (SCI) as a function of neurological level (paraplegia/tetraplegia) and severity (American Spinal Injury Association (ASIA) Impairment Scale (AIS)).

Design

Survey research.

Setting

Three pediatric SCI specialty centers in the USA.

Participants

Youth with SCI ages 5–18 with neurological impairment classifications of: tetraplegia AIS ABC (tetraplegia ABC), paraplegia AIS ABC (paraplegia ABC), or AIS D.

Outcome Measures

Children''s Assessment of Participation and Enjoyment, Pediatric Quality of Life Inventory, Revised Children''s Manifest Anxiety Scale, and Children''s Depression Inventory.

Results

Three hundred and forty youth participated; 57% were male; 60% were Caucasian, 21% Hispanic, 7% African-American, 2% Native American, and 3% reported “other”. Their mean age was 8.15 years (standard deviation (SD) = 5.84) at injury and 13.18 years (SD = 3.87) at interview. Ninety-six youth (28%) had tetraplegia ABC injuries, 191 (56%) paraplegia ABC injuries, and 53 (16%) AIS D injuries. Neurological impairment was significantly related to participation and quality of life (QOL). Specifically, youth with paraplegia ABC and AIS D injuries participated in more activities than youth with tetraplegia ABC (P = 0.002; P = 0.018, respectively) and youth with paraplegia ABC participated more often than youth with tetraplegia ABC (P = 0.006). Youth with paraplegia ABC reported higher social QOL than youth with tetraplegia ABC (P = 0.001) and AIS D injuries (P = 0.002). Groups did not differ regarding mental health.

Conclusion

Interventions should target youth with tetraplegia ABC, as they may need support in terms of participation, and both youth with tetraplegia ABC and AIS D injuries in terms of social integration.     

Autonomic Dysreflexia as a Complication of a Fecal Management System in a Man With Tetraplegia

Background/Objective:

To present a case of autonomic dysreflexia caused by the use of a fecal management system in a patient with tetraplegia.

Design:

Case report.

Setting:

Military rehabilitation center.

Results:

A man with tetraplegia had a fecal management system inserted to divert stool away from his sacral pressure ulcer to reduce contamination and infection risk. Two days later, he developed severe autonomic dysreflexia that improved after removal of the system.

Conclusions:

Autonomic dysreflexia, a life-threatening complication, has not been reported before as a side effect of a fecal management system. These systems should be used with caution in patients with high-level spinal cord injury.     

Reproducibility and effect of posture on impulse oscillation parameters in persons with spinal cord injury

Background

The impulse oscillation system (IOS) offers significant value in the assessment of airway dynamics in persons with spinal cord injury (SCI) because of minimal patient effort but measurement reproducibility in SCI is unknown.

Objective

To evaluate between-day reproducibility and the effect of posture on airway resistance [respiratory resistances at 5 Hz (R5) and 20 Hz (R20)] in subjects with tetraplegia, paraplegia and able-bodied controls.

Methods

Ten subjects with tetraplegia, 10 subjects with paraplegia and 11 able-bodied individuals were evaluated using IOS. Three 30 second trials were obtained in each while in the seated and supine position on Day 1, and repeated on Day 2.

Results

The within-day coefficient of variation (CV%) for R5 and R20 were comparable in the 3 study groups in the seated and supine positions. Compared to controls, the between-day CV% for the combined data was higher in subjects with tetraplegia and paraplegia for R5 seated, and was higher in subjects with tetraplegia for R5 supine.

Conclusions

IOS has applicability to the study of within-day respiratory resistance in SCI. However, performing longer-term studies in subjects with tetraplegia and paraplegia may be problematic because of the greater variability for R5 when compared to able-bodied individuals.     

Incidental discovery of a long standing arteriovenous fistula after thrombectomy for acute lower limb ischaemia

INTRODUCTION

Arteriovenous fistula (AVF) is the abnormal connection between an artery and vein. Congenital AVF of the popliteal artery is very rare.

PRESENTATION OF CASE

89 year old lady presented with right acute lower limb ischaemia. She had unilateral chronic venous hypertensive change in the right leg. Femoral embolectomy was performed. Backflow was achieved. Arteriotomy was closed. The patient''s leg continued to deteriorate. She returned to theatre. On-table angiogram showed an occluded SFA. Thrombectomy was completed. SFA was patent but no blood flowed into the distal popliteal artery. A second on table angiogram revealed AVF between popliteal artery and vein. Dissection to the posterior aspect of the knee revealed the fistula. The vein was arterialized and enlarged. The AVF was ligated. Normal distal blood flow was achieved. Retrospectively we measured the leg lengths. Right leg was 3 cm longer than the left. The right leg circumference was 7 cm greater than the left. She reported chronic venous change from a young age. She did not report any history of trauma to the limb.

DISCUSSION

Popliteal artery to popliteal vein fistula is a rare. Trauma is the most common cause of popliteal AVF. Should the condition develop before closure of the epiphyses, there may be an increase in leg measurements.

CONCLUSION

We postulate that this case of AV fistula may be congenital due to discrepancy in leg measurements and unilateral chronic venous hypertensive change. Rarely persistent remnants of the embryonic sciatic artery can lead to arteriovenous anastomoses, which may be a possible aetiology.     

Intraoperative venous congestion in free transverse rectus abdominis musculocutaneous and deep inferior epigastric artery perforator flaps during breast reconstruction: A systematic review

BACKGROUND:

Even with patent deep inferior epigastric vein anastomoses, venous congestion can occur during free transverse rectus abdominis musculocutaneous (TRAM) or deep inferior epigastric artery perforator (DIEP) flap surgery and lead to flap compromise if not recognized and managed.

OBJECTIVES:

To identify the incidence of intraoperative venous congestion and describe the best available prevention and treatment methods.

METHODS:

Systematic electronic searches of the PubMed database including Medline were performed to identify studies published until 2014. The following keywords were used: “DIEP” or “free TRAM” and “venous insufficiency” or “venous congestion”. Supplemental searches were conducted to identify referenced studies. Statistical analysis using the χ² test was performed.

RESULTS:

Nine studies representing 4747 free abdominal flaps cases were included and demonstrated an overall incidence of intraoperative venous congestion of 2.8%. The incidence in DIEP flaps (3.3%) was significantly higher than that in the free TRAM flaps (1.0%). All nine articles reported using the superficial inferior epigastric vein to treat venous insufficiency.

CONCLUSION:

The risk for developing intraoperative venous congestion following free abdominal flap breast reconstruction is influenced by inadequate perforator selection and persistent dominance in the superficial venous system. The solution is establishing another venous draining route using the superficial inferior epigastric vein.     

Randomized controlled trial of pharmacological replacement of melatonin for sleep disruption in individuals with tetraplegia

Objective

To determine the effectiveness of a melatonin agonist for treating sleep disturbances in individuals with tetraplegia.

Design

Placebo-controlled, double-blind, crossover, randomized control trial.

Setting

At home.

Participants

Eight individuals with tetraplegia, having an absence of endogenous melatonin production and the presence of a sleep disorder.

Interventions

Three weeks of 8 mg of ramelteon (melatonin agonist) and 3 weeks of placebo (crossover, randomized order) with 2 weeks of baseline prior to and 2 weeks of washout between active conditions.

Outcome

Change in objective and subjective sleep.

Measures

Wrist actigraphy, post-sleep questionnaire, Stanford sleepiness scale, SF-36.

Results

We observed no consistent changes in either subjective or objective measures of sleep, including subjective sleep latency (P = 0.55, Friedman test), number of awakenings (P = 0.17, Friedman test), subjective total sleep time (P = 0.45, Friedman test), subjective morning alertness (P = 0.35, Friedman test), objective wake after sleep onset (P = 0.70, Friedman test), or objective sleep efficiency (P = 0.78, Friedman test). There were significant increases in both objective total sleep time (P < 0.05, Friedman test), subjective time in bed (P < 0.05, Friedman test), and subjective sleep quality (P < 0.05, Friedman test), although these occurred in both arms. There were no significant changes in any of the nine SF-36 subscale scores (Friedman test, Ps >Bonferroni adjusted α of 0.005).

Conclusion

In this pilot study, we were unable to show effectiveness of pharmacological replacement of melatonin for the treatment of self-reported sleep problems in individuals with tetraplegia.

Trial Registration

ClinicalTrials.gov # {"type":"clinical-trial","attrs":{"text":"NCT00507546","term_id":"NCT00507546"}}NCT00507546.     

Renal autotransplantation in patients with loin pain–hematuria syndrome

Objective

To determine if renal autotransplantation is an effective treatment for the loin pain–hematuria syndrome.

Design

Retrospective chart review.

Setting

Tertiary care referral centre in Manitoba.

Patients

Four patients referred for diagnosis and management of loin pain–hematuria syndrome. Follow-up for each of the four was 2, 24, 29 and 48 months.

Intervention

Renal autotransplantation.

Main Outcome Measures

Relief of pain with preservation of renal function and blood pressure.

Results

All four patients experienced relief of the pain of loin pain–hematuria syndrome. Renal function was preserved and blood pressure maintained. Narcotic analgesia was discontinued in all cases.

Conclusion

Renal autotransplantation appears to be an effective treatment for patients with loin pain–hematuria syndrome.     

Effect of extended-term estrogen on voiding in a postpartum ovariectomized rat model

Introduction

We tested the hypothesis that extended-term (5-week) estrogen therapy would negatively impact voiding function in a postpartum, ovariectomized rat model.

Methods

Immediately after delivery, 30 primiparous Sprague–Dawley rats underwent intravaginal balloon dilation, followed by ovariectomy 1 week later. Cystometry at postpartum week 2 determined normal or abnormal voiding patterns. After randomization, one-half the normal and abnormal voiding rats received 5 weeks of estrogen therapy, while the remainder received placebo. Estrogen effect was determined by repeat cystometry and immunohistochemical analysis of the urethra and vagina.

Results

Abnormal voiding increased from 60.0% to 73.3% in the estrogen- treated group and declined from 60% to 33% for the placebo group. Rats were then divided into 4 groups for comparison: normal voiding versus placebo (group 1), abnormal voiding versus placebo (group 2), normal voiding versus estrogen (group 3) and abnormal voiding versus estrogen (group 4). Bladder capacity, leak point pressure and maximum voiding pressure were most depressed in group 4. Estrogen treatment was associated with a significant downregulation of α_1A and α_1D-adrenoceptors in the urethral submucosa but an upregulation of nNOS in the urethral smooth muscle.

Conclusion

Extended-term estrogen therapy in a rat model of simulated birth trauma and ovariectomy resulted in a higher rate of incontinence. Immunohistochemical examination demonstrated significant downregulation of urethral α_1A- and α_1D-adrenoceptors and upregulation of neuronal nitric oxide synthase (nNOS) in the urethra of estrogen-treated groups. These studies question the use of hormone replacement therapy in the treatment of postmenopausal incontinence.     

Surgical management of presacral bleeding

Introduction

Presacral venous bleeding is an uncommon but potentially life threatening complication of rectal surgery. During the posterior rectal dissection, it is recommended to proceed into the plane between the fascia propria of the rectum and the presacral fascia. Incorrect mobilisation of the rectum outside the Waldeyer’s fascia can tear out the lower presacral venous plexus or the sacral basivertebral veins, causing what may prove to be uncontrollable bleeding.

Methods

A systematic search of the MEDLINE^® and Embase™ databases was performed to obtain primary data published in the period between 1 January 1960 and 31 July 2013. Each article describing variables such as incidence of presacral venous bleeding, surgical approach, number of cases treated and success rate was included in the analysis.

Results

A number of creative solutions have been described that attempt to provide good tamponade of the presacral haemorrhage, eliminating the need for second operation. However, few cases are reported in the literature.

Conclusions

As conventional haemostatic measures often fail to control this type of haemorrhage, several alternative methods to control bleeding definitively have been described. We propose a practical comprehensive classification of the available techniques for the management of presacral bleeding.     

Canadian Society of Plastic Surgeons Société Canadienne des Chirurgiens Plasticiens: Abstracts presented at the 57th Annual Meeting/57e Réunion annuelle June 25–28 juin,Whistler, British Columbia

INTRODUCTION:

Perforator flaps are increasingly indicated for the often problematic coverage of soft tissue defects in the leg. Knowledge of the vascular supply of the skin is helpful in selecting free or pedicled flaps based on perforator vessels. The objective of this study was to document the vascular supply to the skin of the leg with reference to diameter, pedicle length, location and area supplied by perforator vessels.

METHODS:

A series of 15 fresh human cadavers were injected with the modified lead oxide and gelatin technique. The skin was meticulously dissected preserving all perforators ≥ 0.5 mm in diameter) and their source vessels carefully noting its course through the septa or muscle. Angiograms of the skin were studied and the vascular territory of the source vessels was calculated.

RESULTS:

Seven vascular territories supplied the leg skin. The average number of perforators, percentage of total skin area of the leg supplied, ratio of musculocutaneous to septocutaneous perforators, average diameter (mm), and area supplied (cm²) by each vessel was: Inferior medial genicular [2.4, 6.8%, 3:7, 0.62, 83.2]; Inferior lateral genicular [2.0, 5.3%, 0:1, 0.58, 104]; Descending genicular [6.4, 19.8%, 1:1, 0.84, 254]; Popliteal [4.8, 12.3%, 1:9, 0.87, 280.6]; Posterior Tibial [17.8, 20.8%, 4:1, 0.69, 331]; Anterior Tibial [8.8, 10.0%;4:1;0.60;190.4]; Peroneal [9.8, 11.5%, 7:3, 0.84, 209]. Total number of perforators in the leg was 48 ± 13. The average diameter of the perforators was 0.71 mm.

CONCLUSION:

The cutaneous blood supply was studied and perforating vessels from each source artery described. Large perforator vessels supplying the skin were found in each territory that could be used as potential perforator flaps. This study provides a blueprint of the vascular anatomy of the leg that may be useful for preoperative planning of pedicled and/or free skin flaps.

• Can J Plast Surg. 2003 Summer; 11(2): 95–115.
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• 02: The Effect of Tension on End-To-End Nerve Repair

Can J Plast Surg. 2003 Summer; 11(2): 95.

02: The Effect of Tension on End-To-End Nerve Repair

IRP Sunderland, J Singham, M Brenner, and SE Mackinnon Copyright and License information DisclaimerCopyright © 2003, Pulsus Group Inc. All rights reserved     

Satisfaction with upper extremity surgery in individuals with tetraplegia

Objective

To supplement the scant information available regarding the satisfaction of patients with tetraplegia following upper extremity reconstructive surgery for such individuals with spinal cord injury (SCI).

Study design

Retrospective study with questionnaire follow-up.

Setting

The Danish Spinal Cord Injury Centers.

Material and methods

In the initial review period, 119 upper extremity surgeries were performed on patients with tetraplegia (n = 49). Seven died and the remaining 42 were invited to complete a follow-up questionnaire with a five-level scale ranging from strongly agree to strongly disagree regarding satisfaction. Forty patients completed the questionnaire.

Results

Median time from first surgery was 13 years (2–36). Sixty-five percent of the sample had a C5–C6 SCI, with 64% experiencing complete injury. Initially, 76% of the sample expressed general satisfaction with life, but only 28% of the sample reported that hand appearance improved after surgery. Interestingly, those having surgery from 1991 to 2008 reported significantly greater satisfaction (P < 0.001) and were significantly more satisfied with activities of daily living (ADL) (P < 0.001) than those having surgery between the years 1973 and 1990. In particular, gain of independence was obtained with pinch/specific hand surgery compared to triceps activation. Accordingly, the pinch/specific hand surgery group was significantly more satisfied than the triceps group on the ADL (P = 0.027), and the independence questions (P < 0.001).

Conclusion

Overall satisfaction with upper extremity surgery is high. It can have a positive impact on life in general, ability to perform ADL, as well as supplying an increased level of independence.     

Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: The SCIRehab project

Background/objective

Examine associations of type and quantity of physical therapy (PT) interventions delivered during inpatient spinal cord injury (SCI) rehabilitation and patient characteristics with outcomes at the time of discharge and at 1 year post-injury.

Methods

Physical therapists delivering routine care documented details of PT interventions provided. Regression modeling was used to predict outcomes at discharge and 1 year post-injury for a 75% subset; models were validated with the remaining 25%. Injury subgroups also were examined: motor complete low tetraplegia, motor complete paraplegia, and American Spinal Injury Association (ASIA) Impairment Scale (AIS) D motor incomplete tetra-/paraplegia.

Results

PT treatment variables explain more variation in three functionally homogeneous subgroups than in the total sample. Among patients with motor complete low tetraplegia, higher scores for the transfer component of the discharge motor Functional Independence Measure () are strongly associated with more time spent working on manual wheelchair skills. Being male is the most predictive variable for the motor FIM score at discharge for patients with motor complete paraplegia. Admission ASIA lower extremity motor score (LEMS) and change in LEMS were the factors most predictive for having the primary locomotion mode of “walk” or “both (walk and wheelchair)” on the discharge motor FIM for patients with AIS D injuries.

Conclusion

Injury classification influences type and quantity of PT interventions during inpatient SCI rehabilitation and is a strong predictor of outcomes at discharge and 1 year post-injury. The impact of PT treatment increases when patient groupings become more homogeneous and outcomes become specific to the groupings.

Note

This is the second of nine articles in the SCIRehab series.     

Safety and Efficacy of Medically Performed Tongue Piercing in People with Tetraplegia for Use with Tongue-Operated Assistive Technology

Background:

Individuals with high-level spinal cord injuries need effective ways to perform activities.

Objectives:

To develop and test a medically supervised tongue-piercing protocol and the wearing of a magnet-containing tongue barbell for use with the Tongue Drive System (TDS) in persons with tetraplegia.

Methods:

Volunteers with tetraplegia underwent initial screening sessions using a magnet glued on the tongue to activate and use the TDS. This was followed by tongue piercing, insertion of a standard barbell, a 4-week healing period, and an exchange of the standard barbell for a magnet-containing barbell. This was then used twice weekly for 6 to 8 weeks to perform computer tasks, drive a powered wheelchair, accomplish in-chair weight shifts, and dial a phone. Symptoms of intraoral dysfunction, change in tongue size following piercing, and subjective assessment of receiving and wearing a magnet-containing tongue barbell and its usability with the TDS were evaluated.

Results:

Twenty-one volunteers underwent initial trial sessions. Thirteen had their tongues pierced. One individual’s barbell dislodged during healing resulting in tongue-tract closure. Twelve had the barbell exchanged for a magnet-containing barbell. One subject withdrew for unrelated issues. Eleven completed the TDS testing sessions and were able to complete the assigned tasks. No serious adverse events occurred related to wearing or using a tongue barbell to operate the TDS.

Conclusions:

Using careful selection criteria and a medically supervised piercing protocol, no excess risk was associated with tongue piercing and wearing a tongue barbell in people with tetraplegia. Participants were able to operate the TDS.     

Quantitative measurement of intra-compartmental pressure of the leg in acute traumatic injury: As a routine trend

Background

Experience and literature regarding complications of lower extremity compartment syndrome led us to hypothesize that delayed diagnosis and limb loss are potentially preventable events. Clinical examination does play a role, but quantification of compartment pressure reading serves as confirmation and determines the need for surgical intervention and provides the only objective data in case of conflict.

Methods

We performed a prospective study of all cases of closed tibial fractures presenting to our trauma centre over a 3-year period (January 2009–June 2012). Variables reviewed included intra-compartmental pressure readings, location of the fracture and development of subsequent compartment syndrome requiring fasciotomy. Patients were divided into (1) Group A – proximal tibial fracture, (2) Group B – diaphyseal fracture and (3) Group C – Pilon fracture. Values of the injured and uninjured leg were taken and the data analyzed using SPSS version 22.

Results

168 (41 females and 127 males) cases were analyzed. Mean pressure readings of the fractured limb were higher in Group A compared to the other groups. The mean difference in pressure values between the injured and uninjured limb recorded were of 15.1 mm Hg (Group A), 13.8 mm Hg (Group B) and 13.3 mm Hg (Group C). Patients who eventually underwent fasciotomy were 5 (10.8%) in Group A, 8 (10.3%) in Group B and 3 (6.8%) in Group C, and had initial baseline pressure difference of >18.5 mm Hg.

Conclusion

These data underscore the importance of routine recording of initial intra-compartmental pressure and relation of difference in compartmental pressure between injured and uninjured limb to eventual development of compartment syndrome requiring fasciotomy.     

Comparison of Respiratory Muscle Training Methods in Individuals With Motor Complete Tetraplegia

Objective:

To compare the effects of inspiratory resistance training (IRT) and isocapnic hyperpnea (IH) versus incentive spirometry (placebo) on respiratory function, voice, and quality of life in individuals with motor complete tetraplegia.

Methods:

In this randomized controlled trial, 24 individuals with traumatic, motor complete (AIS A) tetraplegia (C5-C8), 6 to 8 months post injury, were randomly assigned to 1 of 3 groups. They completed either 90 repetitions of IRT, 10 minutes of IH, or 16 repetitions of placebo training in 32 supervised training sessions over 8 weeks. Before and after the training period, the following tests were performed: bodyplethysmography, inspiratory and expiratory muscle strength, subjective breathing parameters using the visual analogue scale (VAS), voice measurements, and an adapted SF-12 quality of life questionnaire. A Friedman test and Cohen’s effect sizes for IRT and IH versus placebo were calculated for differences between pre- and posttraining values.

Results:

Compared to placebo training, IRT showed high effect sizes for inspiratory muscle strength (d = 1.19), VAS values of “cleaning the nose” (d = 0.99), and the physical component of subjective quality of life (d = 0.84). IH compared to placebo training showed only medium and low effect sizes. The Friedman analysis showed a significant effect for IRT versus placebo on inspiratory muscle strength (P = .030). Neither all other parameters of respiratory function nor voice measurements, subjective breathing parameters, or quality of life were significantly improved by one of the tested training methods.

Conclusion:

In individuals with motor complete tetraplegia, inspiratory muscle strength can be improved by IRT. Therefore, IRT is advantageous compared to IH for this group of patients and during the first year post injury.     

Aging exaggerates the blood glucose response to total parenteral nutrition

Objective

To determine the effect of age on the blood glucose and insulin responses to a clinical model of glucose loading (i.e., total parenteral nutrition [TPN] with hypertonic glucose), in patients with a variety of conditions.

Design

A prospective cohort study.

Setting

An adult university hospital.

Patients

Seventy-one consecutive, clinically stable patients receiving central TPN, excluding those with metabolic disease or receiving relevant medications.

Intervention

None.

Main Outcome Measures

Serum levels of glucose, insulin, C-peptide and cortisol determined in peripheral venous blood obtained immediately before initiating TPN and again 48 to 96 hours later; acute physiology score (APS) and habitual level of physical activity (HAL).

Results

Serum levels of glucose, insulin and C-peptide increased following initiation of TPN (all p < 0.001). The serum glucose level during TPN administration increased as a function of both patient age and severity of illness (APS) (r² = 0.37, all p < 0.01), whereas the serum insulin level was inversely related to age and increased as a function of serum glucose, glucose rate of infusion and HAL (r² = 0.57, all p < 0.05). The serum C-peptide:insulin molar ratio did not vary with age.

Conclusions

Aging and severity of illness interact to exaggerate the increases in blood glucose that accompany TPN with hypertonic glucose. Serum insulin responses to TPN decline with aging, likely reflecting reduced insulin secretion. Diminished insulin responses may contribute to hyperglycemia and represent a diminished anabolic signal in such patients. The acutely ill elderly patient is predisposed to hyperglycemia and should be monitored carefully even when pre-TPN blood glucose values are normal.     

Endovascular reconstruction of an interrupted inferior vena cava

INTRODUCTION

Inferior vena cava (IVC) interruption was established as a procedure to treat refractory venous thromboembolism (VTE) complicated by pulmonary embolism. Ilio-caval thrombosis and lower limb chronic venous insufficiency (CVI) are well known long-term complications of IVC interruption, where subsequent treatments may carry significant morbidity and mortality.

PRESENTATION OF CASE

We present here a case of chronic venous insufficiency resulting from IVC interruption with a vascular clip placed forty years previously. A novel approach utilising endovascular stents was used to reconstruct the iliocaval confluence and interrupted distal IVC without the need for laparotomy to remove the plicating clip. This procedure was associated with minimal morbidity and resulted with a quick resolution of the patient''s CVI symptoms.

DISCUSSION

Endovascular angioplasty and stenting is an alternative to open reconstruction of the interrupted inferior vena cava. We have demonstrated successful opening of a plication vascular clip using only endovascular utilities. Advantages include a shorter hospital stay, and reduced morbidity and mortality when compared to a re-do laparotomy.

CONCLUSION

Endovascular stents may be used safely and effectively to reconstruct the surgically interrupted inferior vena cava in the treatment of chronic venous insufficiency.     

Reliability and validity of the capabilities of upper extremity test (CUE-T) in subjects with chronic spinal cord injury

Objective

To determine the reliability and validity of the capabilities of upper extremity test (CUE-T), a measure of functional limitations, in patients with chronic tetraplegia.

Design

Repeated measures.

Setting

Outpatient rehabilitation center.

Participants

Fifty subjects (36 male/14 female) with spinal cord injury (SCI) of ≥1-year duration participated. Subjects were 17–81 years old (mean 48.1 ± 18.2); neurological levels ranged from C2 through T6, American Spinal Injury Association Impairment Scale grades A–D.

Interventions

Not applicable.

Outcome measures

Intraclass correlation coefficients (ICC), weighted kappa and repeatability values for CUE-T; Spearman correlations of CUE-T with upper extremity motor scores (UEMS), and self-care and mobility portions of the Spinal Cord Independence Measure, vIII (SCIM III).

Results

Score ranges for UEMS were 8–50, CUE-T 7–135, self-care SCIM 0–20, and mobility SCIM 0–40. The ICC values for total, right, and left side scores were excellent (0.97–0.98; 95% confidence interval 0.96–0.99). Item weighted kappa values were ≥0.60 for all but five items, four of which were right and left pronation and supination. Repeatability of total score was 10.8 points, right and left sides 6.3 and 6.1 points. Spearman correlations of the total CUE-T with the UEMS and SCIM self-care and mobility scores were 0.83, 0.70, and 0.55 respectively.

Conclusions

The CUE-T displays excellent test–retest reliability, and good–excellent correlation with impairment and capacity measures in persons with chronic SCI. After revising pronation and supination test procedures, the sensitivity to change should be determined.     

The changing demographics of traumatic spinal cord injury: An 11-year study of 831 patients

Context/objective

Traumatic spinal cord injuries (T-SCI) have a devastating impact and place a significant financial burden on the healthcare system. The incidence of T-SCI ranges from 10.4 to 83 cases per million and varies with age, sex, or geographical region. This study describes the epidemiology and demographic characteristics of patients treated for T-SCI in our region over 11 years.

Design

Retrospective cohort study.

Setting

Single Level-I trauma center in Québec, Canada.

Participants

Patients who sustained T-SCI between 1 April 2000 and 31 March 2011.

Interventions

None.

Outcome measures

Data concerning T-SCI patients was retrieved from the Québec Trauma Registry. Information on age, sex, trauma, level of injury, type and severity of neurological deficit (ASIA scale), and treatment was extracted. Annual, age-standardized rates of T-SCI were calculated and trends over time were examined.

Results

Eight hundred and thirty-one patients with T-SCI were identified. The incidence of T-SCI did not change over time but there was a 13-year increase in age between 2002 and 2010. More than 60% of patients aged 55 years or more were injured following a fall and 80% became tetraplegic. These patients were more likely to have central cord syndrome (CCS) and incomplete neurological injury, compared to younger patients. The incidence of CCS increased from 25 to 37% over 11 years.

Conclusions

The T-SCI population is aging and is more frequently sustaining injuries associated with CCS, incomplete neurological deficits and tetraplegia.