Inter-day reliability of blood pressure and cerebral blood flow velocities in persons with spinal cord injury and intact controls

Background: Due to interruption of cardiovascular autonomic control unstable blood pressure (BP) is common in individuals with spinal cord injury (SCI) above the sixth thoracic vertebral level. The impact of unstable BP on cerebral blood flow (CBF) is not well appreciated, but symptoms associated with altered cerebral perfusion are reported, which can negatively impact daily life activities.

Methods: We measured seated BP and CBF in participants with SCI and able-bodied (AB) controls on three laboratory visits to determine the inter-day reliability (intraclass correlation coefficient: ICC). BP was assessed at the finger using photoplethysmography and at the brachial artery with manual sphygmomanometry. CBF velocities (CBFv) were assessed at the middle cerebral artery using transcranial Doppler (TCD) ultrasound.

Results: Data were collected in 15 participants with chronic SCI (C3-T4) and 10 AB controls, the groups did not differ for age, height, weight or BMI; however, brachial BP (P?Conclusions: These data indicate good inter-day reliability of brachial BP and TCD recording of CBFv; however, the assessment of finger BP appears to be somewhat less reliable. In addition, these data confirm reduced resting CBFv in association with hypotension in individuals with SCI compared to matched controls with low BP.     

Reliability of the sit-up test in individuals with spinal cord injury

Abstract

Objective

To determine the day-to-day reliability of blood pressure responses during a sit-up test in individuals with a traumatic spinal cord injury (SCI).

Design

Within-subject, repeated measures design.

Setting

Community outpatient assessments at a research laboratory at the University of British Columbia.

Participants

Five men and three women with traumatic SCI (age: 31 ± 6 years; C4-T11; American Spinal Injury Association Impairment Scale A-B; 1–17 years post-injury).

Outcome measure

Maximum change in systolic (ΔSBP) and diastolic (ΔDBP) blood pressure upon passively moving from a supine to seated position.

Results

The average values for ΔSBP were –11 ± 13 mmHg (range –38 to 3 mmHg) for visit 1, and ?12 ± 8 mmHg (range ?26 to ?1 mmHg) for visit 2. The average values for ΔDBP were ?9 ± 8 mmHg (range -21 to 0 mmHg) for visit 1, and –13 ± 8 mmHg (range –29 to –3 mmHg) for visit 2. The ΔSBP demonstrated substantial reliability with an intraclass correlation coefficient of 0.79 (P = 0.006; 95% CI 0.250–0.953), while the ΔDBP demonstrated almost perfect reliability with an intraclass correlation coefficient of 0.92 (P < 0.001; 95% CI 0.645–0.983). The smallest detectable differences in ΔSBP and ΔDBP were 7 mmHg and 6 mmHg, respectively.

Conclusion

Blood pressure responses to the sit-up test are reliable in individuals with SCI, which supports its implementation as a practical bedside assessment for orthostatic hypotension in this at risk population.     

Reliability of the One-Repetition Maximum Test Based on Muscle Group and Gender

The purpose of the present study was to examine the influence of muscle group location and gender on the reliability of assessing the one-repetition maximum (1RM) test. Thirty healthy males (n = 15) and females (n = 15) who experienced at least 3 months of continuous resistance training during the last 2 years aged 18-35 years volunteered to participate in the study. The 1RM for the biceps curl, lat pull down, bench press, leg curl, hip flexion, triceps extension, shoulder press, low row, leg extension, hip extension, leg press and squat were measured twice by a trained professional using a standard published protocol. Biceps curl, lat pull down, bench press, leg curl, hip flexion, and squat 1RM''s were measured on the first visit, then 48 hours later, subjects returned for their second visit. During their second visit, 1RM of triceps extension, shoulder press, low row, leg extension, hip extension, and leg press were measured. One week from the second visit, participants completed the 1 RM testing as previously done during the first and second visits. The third and fourth visits were separated by 48 hours as well. All four visits to the laboratory were at the same time of day. A high intraclass correlation coefficient (ICC > 0.91) was found for all exercises, independent of gender and muscle group size or location, however there was a significant interaction for muscle group location (upper body vs. lower body) in females (p < 0.027). In conclusion, a standardized 1RM testing protocol with a short warm-up and familiarization period is a reliable measurement to assess muscle strength changes regardless of muscle group location or gender.

Key points

• The one repetition maximum (1RM) test is considered the gold standard for assessing muscle strength in non-laboratory situations.
• This study was done to examine the influence of muscle group location and gender on the reliability of assessing the 1RM test.
• The standardized 1RM testing protocol with a short warm-up and familiarization period is a reliable measurement technique to assess muscle strength changes regardless of muscle group location or gender.

Key words: Reliability, 1RM, resistance exercise     

Low-Frequency Fatigue in Individuals With Spinal Cord Injury

Abstract

Background/Objective: This study examined magnitude and recovery of low-frequency fatigue (LFF) in the quadriceps after electrically stimulated contractions in spinal cord-injured (SCI) and able-bodied subjects.

Subjects: Nine SCI (ASIA A-C, levels C5-T9, injured 13.6 ± 12.2 years) and 9 sedentary able-bodied subjects completed this study.

Methods: Fatigue was evoked in 1 thigh, and the nonfatigued leg served as a control. The fatigue test for able-bodied subjects lasted 15 minutes. For SCI, stimulation was adjusted so that the relative drop in force was matched to the able-bodied group. Force was assessed at 20 (P20) and 100 Hz (PI 00), and the ratio of P20/P100 was used to evaluate LFF in thighs immediately after, at 10, 20, and 60 minutes, and at 2, 4, 6, and 24 hours after a fatigue test.

Results: The magnitude of LFF (up to 1 hour after fatigue) was not different between able-bodied and patients with SCI. However, recovery of LFF over 24 hours was greater in able-bodied compared with patients with SCI in both the experimental (P < 0.001) and control legs (P < 0.001). The able-bodied group showed a gradual recovery of LFF over time in the experimental leg, whereas the SCI group did not.

Conclusions: These results show that individuals with SCI are more susceptible to LFF than able-bodied subjects. In SCI, simply assessing LFF produced considerable LFF and accounted for a substantial portion of the response. We propose that muscle injury is causing the dramatic LFF in SCI, and future studies are needed to test whether “fatigue” in SCI is actually confounded by the effects of muscle injury.     

A Prediction Model for Determining Over Ground Walking Speed After Locomotor Training in Persons With Motor Incomplete Spinal Cord Injury

Background/Objective: To develop and test a clinically relevant model for predicting the recovery of over ground walking speed after 36 sessions of progressive body weight-supported treadmill training (BWSTT) in individuals with motor incomplete spinal cord injury (SCI).

Design: A retrospective review and stepwise regression analysis of a SCI clinical outcomes data set.

Setting: Outpatient SCI laboratory.

Subjects: Thirty individuals with a motor incomplete SCI who had participated in locomotor training with BWSTT. Eight individuals with similar diagnoses were used to prospectively test the prediction model.

Main Outcome Measures: Over ground walking speed was assessed using the 10-m walking test.

Methods: The locomotor training program consisted of 36 sessions of sequential comprehensive training comprised of robotic assisted BWSTT, followed by manual assisted BWSTT, and over ground walking. The dose of locomotor training was standardized throughout the protocol.

Results: Clinical characteristics with predictive value for walking speed were time from injury onset, the presence or absence of voluntary bowel and bladder voiding, a functional spasticity assessment, and over ground walking speed before locomotor training. The model identified that these characteristics accounted for 78.3% of the variability in the actual final over ground walking speed after 36 sessions of locomotor training. The model was successful in prospectively predicting over ground walking speed in the 8 test participants within 4.15 ± 2.22 cm/s in their recovered walking speed.

Conclusions: This prediction model can identify individuals who are most likely to experience success using locomotor training by determining an expected magnitude of training effect, thereby allowing individualized decisions regarding the use of this intensive approach to rehabilitation.     

Visuotemporal cues clinically improved walking ability of ambulatory patients with spinal cord injury within 5 days

Background/Objective: The human movement system uses a variety of inputs to produce movements. The concurrent use of external information, specifically visutemporal cues, while walking could promote the walking ability of ambulatory patients with spinal cord injury (SCI). This study explored the use of visutemporal cues in rehabilitation training by subjecting ambulatory individuals with SCI to walking training with or without visuotemporal cues and then assessing the effects on their functional ability.

Design: Quasi-experimental study.

Setting: A tertiary rehabilitation center.

Participants: Thirty-two participants were randomly assigned to the experimental or control groups using stage of injury, severity of SCI, and baseline walking ability as criteria for group arrangement (16 participants/group).

Interventions: The participants were trained to walk over level ground at their fastest safe speed with or without a visuotemporal cue, 30 minutes/day, for 5 consecutive days.

Outcome Measures: The 10-meter walk test, 6-minute walk test, timed up and go test, and five times sit-to-stand test.

Results: The participants demonstrated significant improvement in all functional tests after the 5 days of training (P?<?0.001). In addition, the improvement in the group trained using the visuotemporal cue was significantly better than that trained without using the cue.

Conclusions: Most of these participants were at a chronic stage of SCI, so the findings supported a benefit for incorporating visuotemporal cues in rehabilitation practice, particularly today when the length of rehabilitation has dramatically decreased.     

Prognostic validity of a clinical trunk control test for independence and walking in individuals with spinal cord injury

Objective: The objective of the present work was to determine the prognostic validity of the trunk control test for walking and independence in individuals with SCI.

Design: A cohort, prospective study was carried out in all individuals with sub-acute SCI.

Setting: All inpatients at the Mexico City based National Rehabilitation Institute (INR).

Participants: Ninety individuals with a clinical diagnosis of sub-acute SCI, American Spinal Injury Association Impairment Scale (AIS) A-D, and that have not participated in a rehabilitation program were included. Thirty-five individuals had good initial trunk control and the remaining 55 had poor trunk control. All individuals participated in a standard rehabilitation program subsequently.

Interventions: N/A

Outcome Measures: The trunk control test was performed at baseline. At 1, 3, 6, 9 and 12 months after the first evaluation, walking and independence were assessed.

Results: Survival Analysis revealed that 62.5% and 100% individuals with good trunk control at baseline assessment were respectively walking and independent in ADL at 12 months and 14% and 48% individuals with poor trunk control were walking and independent in ADL. Cox regression analysis revealed that individuals with good trunk control were 4.6 times more likely to walk independently at 12 months and 2.9 times more likely to be independent in activities of daily living.

Conclusion: The present study revealed that the trunk control test is useful for providing a prognosis of independence and walking at 1 year in individuals with SCI, independently of the neurologic level and the severity of the injury.     

Comparison Between Pre-Exhaustion and Traditional Exercise Order on Muscle Activation and Performance in Trained Men

The purpose of this study was to measure the acute effects of pre-exhaustion vs. traditional exercise order on neuromuscular performance and sEMG in trained men. Fourteen young, healthy, resistance trained men (age: 25.5 ± 4.0 years, height: 174.9 ± 4.1 cm, and total body mass: 80.0 ± 11.1 kg) took part of this study. All tests were randomized and counterbalanced for all subjects and experimental conditions. Volunteers attended one session in the laboratory. First, they performed ten repetition maximum (10RM) tests for each exercise (bench press and triceps pushdown) separately. Secondly, they performed all three conditions at 10RM: pre-test (bench press and triceps pushdown, separately), pre-exhaustion (triceps pushdown+bench press, PE) and traditional (bench press+triceps pushdown, TR), and rested 30 minutes between conditions. Results showed that pre-test was significantly greater than PE (p = 0.031) but not different than TR, for total volume load lifted. There was a significant difference between the pre-test and the time-course of lactate measures (p = 0.07). For bench press muscle activity of the pectoralis major, the last repetition was significantly greater than the first repetition (pre-test: p = 0.006, PE: p = 0.016, and TR: p = 0.005). Also, for muscle activity of the triceps brachii, the last repetition was significantly greater than the first repetition (pre-test: p = 0.001, PE: p = 0.005, and TR: p = 0.006). For triceps pushdown, muscle activity of the triceps brachii, the last repetition was significantly greater than the first repetition (pre-test: p = 0.006, PE: p = 0.016, and TR: p = 0.005). For RPE, there were no significant differences between PE and TR (p = 0.15). Our results suggest that exercise order decreases repetitions performed, however, neuromuscular fatigue, lactate, and RPE are not impacted. The lack of difference in total volume load lifted between PE and TR might explain, at least in part, the similar metabolic and perceptual responses.

Key points

• The effects of different exercise order schemes (e.g. PE and TR) on muscle activity and strength performance indicated that similar responses were observed when comparing these schemes.
• Strength and conditioning coaches should consider these results when prescribing resistance training programs.
• The primary target (e.g. muscle group) of the training session should trained first, when fatigue level low, in order to maximize training outcomes.

Key words: Exercise performance, resistance training, biomechanics     

Characterization of Ultrastructural and Metabolic Abnormalities In Semen from Men With Spinal Cord Injury

Abstract

Background: In men with spinal cord injury (SCI) , fertility is impaired because of a combination of ejaculatory dysfunction and poor semen quality. We hypothesized that ultrastructural and metabolic abnormalities of sperm could be an underlying factor in infertility in these men.

Methods: To investigate mechanisms contributing to the abnormal sperm parameters, we analyzed seminal constituents and sperm ultrastructure in ejaculates from 7 men with SCI and compared them with 5 control subjects. Sperm adenosine triphosphate (ATP) content was measured using a firefly luciferase bioluminescent assay kit, and ultrastructure was evaluated by electron microscopy. Seminal oxidative stress (8-iso-prostaglandin F-2a [8-iso-PGF2a]) and transforming growth factor-β¹(TGF-β¹ J levels were measured by specific enzyme-linked immunoabsorbent assay kits.

Results: Semen samples from men with SCI showed azoospermia (3) and severe asthenospermia (2; motility 0-5%). A majority (65'7'o) of sperm from asthenospermic samples showed degenerative changes and significant axonemal defects. Incubation of normal sperm with SCI seminal plasma induced a concentration-dependent decrease in sperm motility (43%) accompanied by a significant drop in intracellular ATP content (33%). Semen samples from men with SCI exhibited levels of 8-iso-PGF2a 3.5-fold higher than those from controls and levels of TGF-β¹ that were 10% higher than those from controls.

Conclusion: Our results suggest that seminal constituents of men with SCI are detrimental to sperm movement and that ultrastructural degenerative changes may contribute to the impaired sperm motility and viability seen in these patients. These preliminary results must be confirmed in larger patient populations and longitudinal studies.     

Oral probenecid improves sperm motility in men with spinal cord injury

Study Design: Prospective cohort study (twenty men with spinal cord injury [SCI]).

Objective: Determine if administration of oral probenecid results in improved sperm motility in men with SCI.

Setting: Major university medical center.

Methods: Twenty men with SCI were administered probenecid for 4 weeks (250?mg twice a day for 1 week, followed by 500?mg twice a day for 3 weeks). Semen quality was assessed at three time points: pre-treatment, post-treatment (immediately after the 4-week treatment), and follow-up (4 weeks after the last pill was ingested).

Result(s): Probenecid was well-tolerated by all subjects. Sperm motility improved in each subject after 4 weeks of oral probenecid. The mean percent of sperm with progressive motility increased from 19% to 26% (P < 0.05). A more striking increase was seen in the mean percent of sperm with rapid linear motility, from 5% to 17%, (P <0.001). This improvement continued into the four week follow up period. Similar improvements were seen in the total motile sperm count (15 million, 28 million, and 27 million at pre-treatment, post-treatment, and follow-up, respectively). Sperm concentration was not significantly different at pre-treatment, post-treatment, and follow-up, (52 million, 53 million and 53 million, respectively).

Conclusion: This study showed that administration of an oral agent (probenecid) known to interfere with the pannexin-1 cellular membrane channel, can improve sperm motility in men with spinal cord injury. It is the first study to report improved sperm motility after oral medication in men with SCI.     

Reliability and Repeatability of the Motor and Sensory Examination of the International Standards for Neurological Classification of Spinal Cord Injury

Abstract

Objective: To determine the reliability and repeatability of the motor and sensory examination of the International Standards for Classification of Spinal Cord Injury (SCI) in trained examiners.

Participants/Methods: Sixteen examiners (8 physicians, 8 physical therapists) with clinical SCI experience and 16 patients participated in a reliability study in preparation for a clinical trial involving individuals with acute SCI. After a training session on the standards, each examiner evaluated 3 patients for motor, light touch (LT), and pin prick (PP). The following day, 15 examiners reevaluated one patient. Interrater reliability was determined using intraclass correlation coefficients (1-way, random effects model). Intrarater reliability was determined using a 2-way random effects model. Repeatability was determined using the method of Bland and Altman.

Results: Patients were classified as complete tetraplegia (n = 5), incomplete tetraplegia (n = 5), complete paraplegia (n = 5), and incomplete paraplegia (n = 1). Overall, inter-rater reliability was high: motor = 0.97, LT = 0.96, PP = 0.88. Repeatability values were small in patients with complete SCI (motor < 2 points, sensory < 7 points) but large for patients with incomplete SCI. Intra-rater reliability values were > 0.98 for patients with complete SCI.

Conclusions: The summed scores for motor, LT, and PP in subjects with complete SCI have high interrater reliability and small repeatability values. These measures are appropriately reliable for use in clinical trials involving serial neurological examinations with multiple examiners. Further research in subjects with incomplete SCI is needed to determine whether repeatability is acceptably small.     

Nitrite and Leukocyte Dipstick Testing For Urinary Tract Infection in Individuals With Spinal Cord Injury

Abstract

Objective: Todetermine sensitivity, specificity, and positive and negative predictive values of nitrite (NIT) and leukocyte esterase (LE) testing in relation to Iabaratory evidence of significant bacteriuria and urinary tract infection (UTI) in persons with spinal cord injury (SCI).

Design: Monthly urine cultures were compared with results of dipstick testing. Setting: Community based.

Methods: Fifty-six people with SCI were evaluated on a monthly basis with dipstick testing for NIT and LE as weil as urine cultures. Participants reported whether they believed that they had a UTI and, if so, whether they were treated for the UTI and what symptoms they had experienced.

Results: The sensitivity rate for the most comprehensive criteria-defined as positive NIT test, a positive LE positive, or both a positive NIT test and positive LE test-was 0.64 and the specificity rate was only 0.52. No singletype ofbacteria was found to occur in more than 3 0% of the urine samples.

Conclusion: Reliance on dipstick testing for NIT and LEin individuals with SCI can Iead to high rates of overtreatment for UTI, given the fact that regular catheterization is associated with significant bacteriuria. lndividuals with SCI should be evaluated with urine culture to ensure proper treatment.     

The Relationship Between Isometric and Dynamic Strength in College Football Players

Previous research has demonstrated the importance of both dynamic and isometric maximal strength and rate of force development (RFD) in athletic populations. The purpose of this study was to examine the relationships between measures of isometric force (PF), RFD, jump performance and strength in collegiate football athletes. The subjects in this study were twenty-two men [(mean ± SD):age 18.4 ± 0.7 years; height 1.88 ± 0.07 m; mass 107.6 ± 22.9 kg] who were Division I college football players. They were tested for PF using the isometric mid thigh pull exercise. Explosive strength was measured as RFD from the isometric force-time curve. The one repetition maximum (1RM) for the squat, bench press and power clean exercises were determined as measures of dynamic strength. The two repetition maximum (2RM) for the split jerk was also determined. Vertical jump height and broad jump was measured to provide an indication of explosive muscular power. There were strong to very strong correlations between measures of PF and 1RM (r = 0. 61 - 0.72, p < 0.05). The correlations were very strong between the power clean 1RM and squat 1RM (r = 0.90, p < 0.05). There were very strong correlations between 2RM split jerk and clean 1RM (r = 0.71, p < 0.05), squat 1RM (r = 0.71, p < 0.05), bench 1RM (r = 0.70, p < 0.05) and PF (r = 0.72, p < 0.05). There were no significant correlations with RFD. The isometric mid thigh pull test does correlate well with 1RM testing in college football players. RFD does not appear to correlate as well with other measures. The isometric mid thigh pull provides an efficient method for assessing isometric strength in athletes. This measure also provides a strong indication of dynamic performance in this population.

Key points

• In Division I college football players the isometric mid thigh pull test correlates well with 1RM testing.
• Rate of Force Development does not appear to be as closely related to dynamic and isometric strength in college football players.
• The isometric mid thigh pull provides a quick and efficient method for assessing isometric strength in athletes.

Key words: Isometric strength, American football, power     

Pulse Wave Velocity for Assessment of Arterial Stiffness Among People With Spinal Cord Injury: A Pilot Study

Background/Objective: The most significant complication and leading cause of death for people with spinal cord injury (SCI) is coronary artery disease (CAD). It has been confirmed that aortic pulse wave velocity (PVW) is an emerging CAD predictor among able-bodied individuals. No prior study has described PWV values among people with SCI. The objective of this study was to compare aortic (the common carotid to femoral artery) PWV, arm (the brachial to radial artery) PVW, and leg (the femoral to posterior tibial artery) PVW in people with SCI (SCI group) to able-bodied controls (non-SCI group).

Methods: Participants included 12 men with SCI and 9 non-SCI controls matched for age, sex, height, and weight. Participants with a history of CAD or current metabolic syndrome were excluded. Aortic, arm, and leg PVW was measured using the echo Doppler method.

Results: Aortic PVW (mean ± SD) in the SCI group (1,274 ± 369 cm/s) was significantly higher (P < 0.05) than in the non-SCI group (948 ± 110 cm/s). There were no significant between-group differences in mean arm PVW (SCI: 1,152 ± 193 cm/s, non-SCI: 1,237 ± 193 cm/s) or mean leg PVW (SCI: 1,096 ± 1 73 cm/s, non-SCI: 994 ±178 cm/s) values.

Conclusions: Aortic PVW was higher among the SCI group compared with the non-SCI group. The higher mean aortic PVW values among the SCI group compared with the non-SCI group indicated a higher risk of CAD among people with SCI in the absence of metabolic syndrome.     

Antispasmodic medications may be associated with reduced recovery during inpatient rehabilitation after traumatic spinal cord injury

Objective: To determine whether antispasmodic medications are associated with neurological and functional outcomes during the first year after traumatic spinal cord injury (SCI).

Design/Methods: Retrospective analysis of prospectively collected data from six inpatient SCI rehabilitation centers. Baseline-adjusted outcomes at discharge and one-year follow-up were compared using analysis of covariance between patients who received antispasmodic medication on at least 5 days during inpatient rehabilitation and patients who did not.

Outcome measures: Rasch-transformed motor subscore of the Functional Independence Measure (FIM); International Standards for Neurological Classification of Spinal Cord Injury motor scores, grade, and level.

Results: Of 1,259 patients, 59.8%, 35.4%, and 4.8% were injured at the cervical, thoracic, and lumbosacral levels, respectively. 65.6% had motor complete injury. Rasch-transformed motor FIM score at admission averaged 23.3 (95% confidence interval (CI) 22.4–24.2). Total motor score averaged 39.2 (95% CI 37.8–40.6). 685 patients (54.4%) received one or more antispasmodic medications on at least 5 days. After controlling for demographic and injury variables at admission, Rasch-transformed motor FIM scores at discharge were significantly lower (P?=?0.018) in patients receiving antispasmodic medications than in those who did not. This trend persisted in secondary analyses for cervical, thoracic, and lumbosacral subgroups. Multivariate regression showed that receiving antispasmodic medication significantly contributed to discharge motor FIM outcome. At one-year follow-up, no outcomes significantly differed between patients ON or OFF antispasmodics.

Conclusions: Antispasmodic medications may be associated with decreased functional recovery at discharge from inpatient traumatic SCI rehabilitation. Randomized prospective studies are needed to directly evaluate the effects of antispasmodic medication on recovery.     

Lipid Profiles of Persons With Paraplegia and Tetraplegia: Sex Differences

Abstract

Background/Objective: To examine the lipoprotein profiles of men and women with paraplegia and tetraplegia. Impairment of the sympathetic nervous system (dependent on the level of injury) and the extent of physical capacity and activity were correlated with the lipid profile in men with spinal cord injury (SCI). Sex-related differences of the lipoprotein profiles could be found in nondisabled and premenopausal women with SCI mainly because of the different effects of sexual hormones.

Methods: Lipoprotein profiles of 112 participants with SCI (32 premenopausal women, 80 men) were analyzed and correlated to sex, lesion level, and physical performance capacity.

Results: Women with tetraplegia or paraplegia showed significantly higher levels of high-density lipoprotein and lower ratios of total cholesterol to high-density lipoprotein-cholesterol compared with men with corresponding lesion levels, without a difference in peak oxygen consumption. Concentrations of very-low-density lipoproteins were lower in women with paraplegia than in men with paraplegia, no differences were found in total cholesterol, low-density lipoprotein-cholesterol, and triglycerides. Sexindependent elevations in total cholesterol and low-density lipoprotein-cholesterol were associated with paraplegia, and sex-independent elevations in triglyceride levels were associated with tetraplegia.

Conclusions: Persons with SCI showed sex-related differences in their lipoprotein profiles. Independent of physical fitness, the lipoprotein profile of premenopausal women with SCI did not exhibit the adverse lipoprotein characteristics observed in men with SCI, probably because of the influence of sexual hormones independent of lesion level.     

Patterns of cognitive deficits in persons with spinal cord injury as compared with both age-matched and older individuals without spinal cord injury

Context/Objective: Cognitive deficits can impact as many as 60% of individuals with spinal cord injury (SCI). In an effort to identify the nature of cognitive deficits in SCI, we examined neuropsychological test performance in individuals with SCI, age matched healthy controls and older healthy controls.

Design: Participants completed a motor-free neuropsychological test battery assessing attention, working memory, information processing speed, new learning /memory and executive control.

Setting: Outpatient rehabilitation research facility.

Participants: Participants included 60 individuals with chronic spinal cord injury [SCI; 32 with paraplegia (T2-T12) and 28 with tetraplegia (C3-T1)], 30 age-matched healthy controls (AMHC; 30–40 years old) and 20 older healthy controls (OHC; 50–60 years old).

Outcome Measures: Wechsler Intelligence Scale – 3^rd edition (WAIS-III) Digit Span and Letter-Number Sequencing; Symbol Digit Modalities Test (SDMT) – oral version; California Verbal Learning Test-II; Paced Auditory Serial Addition Test (PASAT); Wechsler Abbreviated Scale of Intelligence (WASI); Delis-Kaplan Executive Function System; Verbal Fluency subtest.

Results: Significant differences were noted between the SCI and AMHC groups on measures of information processing speed, new learning and memory, and verbal fluency. No significant differences were noted between the groups on tests of attention or working memory.

Conclusion: The current study documented differences in specific realms of cognitive functioning between a chronic SCI sample and AMHC. Implications for cognitive rehabilitation and overall quality of life are discussed. Additional research is needed utilizing a more comprehensive battery of motor-free neuropsychological tests that avoid the confound of upper limb motor limitations on cognitive performance.     

Systemic Naloxone Infusion May Trigger Spasticity in Patients With Spinal Cord Injury: Case Series

Abstract

Background/Objective: Three patients with spinal cord injury (SCI) and 3 able-bodied (AB) patients were infused with naloxone during a study to examine their neuroendocrine function. An unanticipated side effect occurred during the naloxone infusion. All 3 patients with SCI, but none of the AB patients, experienced profoundly increased spasticity during the naloxone infusion. Our report describes this side effect, which has potential implications for the clinical treatment or scientific evaluation of individuals with SCI.

Methods: All patients were in good general health and medication free for 11 days or longer before the study. Each patient was placed on a 30-hour protocol to analyze pulsatile release of gonadotropins. Physiologic saline was intravenously infused on day 1 to serve as a control period for naloxone infusion on day 2.

Results: AB patients experienced no muscle spasm activity or any other side effects at any time during the study. In contrast, all 3 patients with SCI experienced a profoundly increased frequency and duration of spasticity in muscles innervated by the nerve roots caudal to their level of injury. In all 3 patients with SCI, spasticity increased only during the period of naloxone infusion. Within 1 hour of stopping naloxone, spasticity returned to baseline levels.

Conclusions: Naloxone infusion produced a differential effect on the muscle activity of men with SCI compared to AB men with intact spinal circuits. Consistent with previous studies, the results of this study indicate a relationship between opioid neuromodulation and spasticity after SCI.     

Efficacy And Safety Of Oral Sildenafil In Men With Erectile Dysfunction And Spinal Cord Injury

Abstract

Objective: To assess the efficacy of sildenafil in men with spinal cord injury (SCI) and erectile dysfunction (ED).

Methods: Seventeen men with SCI were selected from February to September 1998 for sildenafil treatment of ED. The initial dose of 25-mg was increased by 25-mg increments as needed. Patients underwent baseline physical examination and answered questions from the abridged International Index of Erectile Function before and during therapy.

Results:Sixteen patients tolerated therapy; 1 developed hypotension and dis continued therapy. There was significant improvement in erectile function (P < .05) after 5.3 ± 2.2 months when compared with baseline or previous therapies (P < .05). Of the 17 patients,94% recommended sildenafil to others. Six of these16 patients were available for long-term follow-up. There was further significant improvement in quality of erection (P < .05), but no change in satisfaction.

Conclusion:Sildenafil is effective and well tolerated in men with SCI and ED.     

The International Standards for Neurological Classification of Spinal Cord Injury: Intra-Rater Agreement of Total Motor and Sensory Scores in the Pediatric Population

Background: The International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI) is the gold standard for evaluating and classifying the neurological consequence of spinal cord injury (SCI). Objective: To determine the within-rater agreement for total scores of light touch (LT), pin prick (PP), and total motor (TM) in children and youth.

Design: Part of a larger cross-sectional study to determine the intra-rater reliability of the standards when applied to children and youth.

Participants/Methods: A total of 187 subjects participated in 2 repeated examinations performed by the same rater. A total of 7 raters participated in this study. Intraclass correlations coefficients (ICCs), with 95% Cl were calculated to determine agreement between the 2 examinations for LT, PP, and TM.

Results: With the exception of subjects younger than 6 years, agreement on repeated total PP, LT, and TM scores were good to excellent, as shown by ICC values of 0.92 or higher. Although agreement was high for the youngest age group for LT (ICC = 0.920), PP (ICC = 0.957), and TM (ICC = 0.971), all of the lower 95% Cl values fell well below 0.66, indicating poor precision. All subgroups had good to high agreement for total PP, LT, and TM scores, as indicated by ICC values of 0.87 and higher. There were lower 95% Cl (LCI) values for the 6- to 11-year-old group with incomplete paraplegia due to the low number of subjects in that subgroup (N = 4). The LCI values were poor for PP for the subgroups with 6- to 11-year-olds with incomplete tetraplegia (LCI = 0.675) and the 12- to 15-year-old group with incomplete paraplegia (LCI = 0.707) and for TM for 16- to 21-year-old group with complete paraplegia (LCI = 0.706).

Conclusions: In children as young as 6 years, within-rater agreement on LT, PP, and TM exceeded recommended values for clinical measures. With the exception of 6- to 11-year-olds with incomplete injuries, type of injury and severity of injury were not factors in agreement. Although more work is needed to define the lower age limit in which the ISCSCI have utility, these data represent growing evidence supporting the use of the ISCSCI when evaluating the neurological consequence of SCI in children.