Duplex ultrasound screening for deep vein thrombosis in spinal cord injured patients at rehabilitation admission.

OBJECTIVE: To determine the rate of deep vein thrombosis (DVT) newly diagnosed by duplex ultrasound in patients with acute spinal cord injury (SCI) at admission for rehabilitation. DESIGN: Retrospective case-control study. SETTING: Independent specialized spinal cord rehabilitation hospital. PATIENTS: Data were collected from records of 189 SCI patients admitted for rehabilitation over a 1-year period who underwent a duplex scan and were not admitted with a known diagnosis of DVT. MAIN OUTCOME MEASURES: A DVT newly diagnosed by duplex ultrasound at rehabilitation admission. RESULTS: Twenty-two patients (11.6%) had a newly diagnosed DVT at time of admission. Chi-square analysis found no statistically significant relationship between level of injury (tetraplegia vs paraplegia), motor complete (ASIA A and B) versus incomplete status (ASIA C and D), or cause of SCI (traumatic vs nontraumatic injury) in determining a positive or negative duplex result (chi2 = 1.709, p = .191; chi2 = 1.314, p = .252; chi2 = 3.155, p = .076; respectively). Prophylaxis for DVT decreased the risk of developing a DVT: 4.1% of patients administered prophylaxis as compared to 16.4% of patients not given prophylaxis (chi2 = 6.558, p = .01). Only 38.6% of patients transferred to rehabilitation were undergoing DVT prophylaxis. CONCLUSIONS: The prevalence of DVT in acute SCI patients at admission to rehabilitation is significant. A duplex ultrasound is an important noninvasive technique to screen patients with acute and subacute SCI for DVT on admission to the rehabilitation setting regardless of the completeness, level, or cause of the patients' injury.     

多学科团队管理对脑损伤吞咽障碍患者吞咽功能的影响

目的:探讨多学科团队管理对脑损伤吞咽障碍患者吞咽功能的疗效影响。方法:入选脑损伤后吞咽障碍患者60例,随机分为对照组和观察组各30例,其中对照组采用常规综合吞咽障碍康复方案,观察组在常规方案的基础上采用多学科吞咽团队管理方案。使用洼田饮水试验、视频透视吞咽功能检查(Video Fluoroscopic Swallowing Study,VFSS)比较2组患者吞咽功能改善程度,使用体重指数(Body Mass Index,BMI)18.5、吸入性肺炎发生率比较2组并发症发生情况。结果:干预4周后,2组洼田饮水试验结果分级显示吞咽功能均较组内治疗前明显改善(P0.01),且观察组吞咽功能明显优于对照组(P0.01)。观察组吞咽功能障碍恢复总有效率明显高于对照组(P0.05)。2组VFSS评分均较治疗前明显提高(P0.01),观察组更高于对照组(P0.01)。观察组拔管率明显高于对照组(P0.05);观察组营养不良及吸入性肺炎发生率均明显低于对照组(P0.05)。结论:多学科吞咽团队管理下进行的康复干预方案可有效改善脑损伤吞咽障碍患者的吞咽功能及脑损伤后吞咽障碍患者营养不良,降低吸入性肺炎的发生率。     

Dysphagia Characteristics of Patients Post SARS-CoV-2 During Inpatient Rehabilitation

ObjectiveTo investigate dysphagia in patients recovering from SARS-CoV-2 admitted to acute inpatient rehabilitation by summarizing clinical swallow evaluation and videofluoroscopic swallow study findings.DesignRetrospective cohort study.SettingUrban inpatient rehabilitation hospital.ParticipantsThe first inpatients admitted with SARS-CoV-2 (N=40) who participated in a videofluoroscopic swallow study.InterventionsNot applicable.Main Outcome MeasuresPatient characteristics upon admission (duration of intubation, tracheostomy status, comorbidities, videofluoroscopic swallow study (VFSS) completion at previous level of care); admission International Dysphagia Diet level (IDDSI); Mann Assessment of Swallowing Ability (MASA), Functional Oral Intake Scale (FOIS), dysphagia severity rating; penetration aspiration scale (PAS) rated during VFSS; and IDDSI level recommended after completion of VFSS.ResultsTwenty percent of patients had been evaluated by videofluoroscopy in acute care. Nineteen of 37 (51%) individuals were upgraded to IDDSI level 7 regular diet with level 0 thin liquids and achieved a FOIS of 7 after the completion of the VFSS. Five individuals (13%) received a diet downgrade or remained on the same diet recommendations from their admission. Total numerical score (TNS) of less than 170 on the MASA predicted presence of aspiration in 27% of patients (6 of 22). Seventy-two percent of the sample (16 of 22) had a TNS less than 170 but did not demonstrate any instances of aspiration. The odds of patients having a PAS of 3 or greater increased by approximately 15% (odds ratio, 1.15; 95% confidence interval, 1.03-1.27; P=.013). Thus, with each additional day of intubation during acute care stay, there was a 15% greater likelihood of having airway invasion.ConclusionsInstrumental swallow evaluations are imperative to diagnose and treat dysphagia in the post-coronavirus disease population. Because of the heterogeneity of this population, high incidence of prolonged intubation, and limitations of the clinical swallowing evaluation, instrumental assessments need to be performed on a more consistent basis as infection prevention protocols evolve.     

急性脑梗死后吞咽障碍早期康复治疗的疗效观察

目的:探讨急性脑梗死后吞咽障碍患者早期康复治疗的临床疗效。方法:90例急性脑梗死后吞咽障碍患者随机分为康复组和对照组各45例,均给予神经内科常规治疗,康复组还予系统康复训练治疗,采用VFSS于治疗前、治疗2、4周后检查患者的吞咽障碍程度,并比较2组疗效。结果:治疗后2、4周,2组VFSS评分均优于治疗前,且康复组疗效优于对照组(P0.05)。结论:对急性脑梗死后吞咽障碍患者进行早期吞咽功能训练,提高了疗效。     

Duration of dysphagic symptoms and swallowing outcomes after thermal burn injury.

Levels of swallowing disability, patterns of dysphagia rehabilitation and swallowing outcomes on discharge were retrospectively reviewed for 30 patients with thermal burn injury (with or without inhalation injury), referred to speech pathology services for dysphagia management. The average total surface burn area of the group was 50%. All patients were mechanically ventilated for an average of 24 days, with 80% of patients requiring subsequent tracheostomy. Initial dysphagia assessment occurred approximately 20 days after admission, whereas first safe oral intake was achieved by approximately 30 days. Supplementary nutrition and hydration was necessary for all patients. The time to achieve oral intake without supplementation was 53 days. Outcome measures revealed a significant improvement in swallowing function throughout the duration of inpatient stay, with 90% of patients discharged safely tolerating a normal diet, 6.7% of patients managing soft diet consistencies, and 3.3% managing soft puree consistencies on discharge.     

Cost-effectiveness of duplex ultrasound surveillance in spinal cord injury

OBJECTIVE: To determine cost-effectiveness of surveillance with duplex ultrasound for thromboembolic disease in individuals with acute traumatic spinal cord injury at admission to rehabilitation. DESIGN: In this retrospective sequential case series study, individuals with traumatic spinal cord injury admitted to our rehabilitation facility between July 1, 1988, and December 31, 1998, were identified. Cost at our institution for treatment of thromboembolic disease was tabulated in 2001-2002 dollar amounts. Using this cost information, in a statistical model founded on available medical evidence, analysis for cost-effectiveness was then performed. RESULTS: A total of 369 subjects met inclusion criteria. Based on the statistical model, the cost and estimated mortality from thromboembolic disease per subject when performing admission duplex ultrasounds was $449.28 and 0.016%, respectively. The estimated total cost per subject when not performing admission duplex ultrasounds was $136.29, with predicted mortality of 0.524% due to thromboembolic disease. Therefore, cost of one life saved when performing admission duplex ultrasound surveillance is calculated to be $61,542, with cost per life year gained between $1193 and $9050, depending on age at time of injury and severity of injury. CONCLUSION: Duplex ultrasound is a cost-effective tool for deep venous thrombosis surveillance in individuals with acute traumatic spinal cord injury admitted to rehabilitation programs.     

Neoplastic versus traumatic spinal cord injury: an outcome comparison after inpatient rehabilitation.

OBJECTIVE: To compare outcomes of patients with neoplastic spinal cord compression (SCC) to outcomes of patients with traumatic spinal cord injury (SCI) after inpatient rehabilitation. DESIGN: A comparison between patients with a diagnosis of neoplastic SCC admitted to an SCI rehabilitation unit and patients with a diagnosis of traumatic SCI admitted to the regional Model Spinal Cord Injury Centers over a 5-year period, controlling for age, neurologic level of injury, and American Spinal Injury Association impairment classification. SETTING: Tertiary university medical centers. PATIENTS: Twenty-nine patients with neoplastic SCC and 29 patients with SCI of traumatic etiology who met standard rehabilitation admission criteria. MAIN OUTCOME MEASURES: Acute and rehabilitation hospital length of stay (LOS), Functional Independence Measure (FIM) scores, FIM change, FIM efficiency, and discharge rates to home. RESULTS: Patients with neoplastic SCC had a significantly (p < .01) shorter rehabilitation LOS than those with traumatic SCI (25.17 vs 57.46 days). No statistical significance was found in acute care LOS. Motor FIM scores on admission were higher in the neoplastic group, but discharge FIM scores and FIM change were significantly lower. Both groups had similar FIM efficiencies and community discharges. CONCLUSIONS: Patients with neoplastic SCC can achieve rates of functional gain comparable to those of their counterparts with traumatic SCI. While patients with traumatic SCI achieve greater functional improvement, patients with neoplastic SCC have a shorter rehabilitation LOS and can achieve comparable success with discharge to the community.     

颈髓损伤患者吞咽障碍危险因素分析

目的 分析颈髓损伤患者发生吞咽障碍的影响因素，为临床筛查和干预提供依据。 方法 选取符合纳入标准的颈髓损伤患者病例资料110例，根据功能性经口进食量表评估颈髓损伤患者吞咽功能，分为重度吞咽障碍组（19例）、轻度吞咽障碍组（35例）和正常吞咽功能组（56例），颈髓损伤后吞咽障碍的发生率为49.1%（54/110）。收集110例患者的性别、年龄、损伤平面、损伤程度、损伤时间、损伤原因、手术方式、气管切开状态、是否发生肺炎、是否发生咽部肿胀等相关临床资料；对可能影响颈髓损伤患者吞咽功能的资料进行单因素和多因素Logistic回归分析。 结果 单因素Logistic回归分析显示，患者的损伤严重程度、气管切开状态、住院期间是否发生肺炎以及是否发生咽部肿胀可能会影响颈髓损伤患者吞咽功能（P＜0.05）。将上述单因素分析中P＜0.01的变量（气管切开状态、是否发生肺炎、是否发生咽部肿胀）纳入无序多分类Logistic回归分析，结果显示，气管切开状态［OR=12.927，95% CI=(2.034,82.177)］、住院期间发生肺炎［OR=5.537，95% CI=(1.258,24.367)］是颈髓损伤患者发生重度吞咽障碍的独立危险因素（P＜0.05）。 结论 患者气管切开状态、有肺部炎症可能是颈髓损伤重度吞咽障碍患者的危险因素。     

Swallowing disorders in severe brain injury: risk factors affecting return to oral intake

OBJECTIVE: To determine the incidence and type of swallowing disorders that accompany severe brain injury and to identify factors that affect oral intake. DESIGN: Inception cohort study. SETTING: Level I trauma center. PATIENTS: Consecutively admitted patients with severe brain injury who achieved cognitive levels during admission to assess swallowing and who did not sustain injuries preventing swallowing assessment (n = 54). MAIN OUTCOME MEASURES: Type of swallowing abnormalities and presence of aspiration evident on videofluoroscopic swallow studies (VFSS), days to initiation and achievement of oral feeding, ventilation days, presence of a tracheostomy, and cognitive levels at initiation and achievement of oral feeding. RESULTS: Sixty-one percent of subjects exhibited abnormal swallowing. Loss of bolus control and reduced lingual control occurred most commonly. Aspiration rate was 41%. Normal swallowers achieved oral feeding in 19 days versus 57 days for abnormal swallowers. Rancho Los Amigos (RLA) Level IV was needed for initiation of oral feeding; Level VI was needed for total oral feeding. Risk factors for abnormal swallowing included: lower admission Glasgow Coma Scale (GCS) and RLA scores, presence of a tracheostomy, and ventilation time longer than 2 weeks. Risk factors for aspiration were lower admission GCS and RLA scores. CONCLUSIONS: Swallowing disorders and behavioral/cognitive skills are frequently present in patients with severe brain injury and significantly affect oral intake of food. Persons who swallow abnormally take significantly longer to start eating and to achieve total oral feeding, and they require nonoral supplementation three to four times longer than those who swallow normally.     

脑卒中急性期吞咽障碍的临床影像评价

目的:探讨脑卒中急性期吞咽障碍的临床及影像学检查的表现,分析脑卒中部位与吞咽障碍发生类型的关系。方法:首次发病的急性脑卒中患者62例,根据不同病变部位分为单侧大脑半球组、双侧大脑半球组、脑干与小脑组及多发性卒中组。入院后3d内完成临床吞咽功能评估;入院7d进行吞咽X线荧光透视检查(VFSS);记录分析吞咽障碍的类型和脑卒中的病变部位。结果:入院3d内临床吞咽评定4组患者中有29例(46.8%)存在吞咽困难,其中脑干及小脑组发生吞咽困难的百分率明显高于其他组(P0.05);于7d时VFSS检测11例能完成,其中单侧大脑半球组3例、双侧大脑半球组2例,多出现口腔期困难;脑干及小脑组2例,多出现咽期困难;多发卒中组4例,口腔期和咽期均受影响。吞咽异常表现类型为唇闭合无力、舌运动减弱、误吸及环咽肌功能不全、吞咽反射延迟、喉上抬差、会厌谷和/或梨状窝滞留、喉渗透等。结论:脑卒中后吞咽障碍的临床评定可明确吞咽口阶段的生理状态,VFSS可明确咽阶段及有无误吸。为避免吞咽困难所致的并发症及预防或治疗吞咽困难,需尽早完成吞咽评定,且可以节省患者总体费用及加快改善预后。     

Functional improvement after pediatric spinal cord injury

OBJECTIVE: To describe the functional gain (FGain) with pediatric spinal cord injury inpatient rehabilitation and to identify the relationship of various factors to FGain in pediatric spinal cord injury inpatient rehabilitation. DESIGN: Retrospective chart review of a series of 91 children with spinal cord injury admitted from 1993 to 1998 in a freestanding rehabilitation hospital. Admission and discharge functional status were assessed with the Pediatric Functional Independence Measure (WeeFIM) instrument for children 7 yr. The outcome measure is the FGain (difference between the discharge and admission functional status). RESULTS: Significant gains in functional status were observed in all patients. FGain was not significantly related to age, sex, length of inpatient rehabilitation, pathogenesis, or completeness or neurologic level of injury. However, there was a trend for higher FGain for patients with incomplete spinal cord injury and traumatic spinal cord injury. CONCLUSIONS: Functional improvement occurs with pediatric spinal cord injury inpatient rehabilitation. There is a trend for higher FGain in patients with less severe injury and traumatic injury. The lack of relationship between FGain and length of inpatient rehabilitation suggests that a variety of other factors influence the relationship between FGain and length of inpatient rehabilitation.     

Substance abuse, violence, and outcome after traumatic spinal cord injury.

Alcohol and drug use have been shown to contribute to the onset of traumatic spinal cord injury and to be a marker for later onset substance abuse issues. Admission toxicology (drug and alcohol) screens were collected from 87 consecutive rehabilitation medicine patients with a diagnosis of acute traumatic spinal cord injury. Forty-six patients (53%) presented with positive screens (44% alcohol only, 30% drug only, 26% both). Seventy-five percent of those with positive alcohol screens met state criteria for alcohol intoxication (blood alcohol level, > or =0.08 mg/dl). Compared with individuals with negative screens, those with positive screens were significantly (P < 0.05) younger and unmarried. Compared with nonviolence-related spinal cord injury, patients with violence-related spinal cord injury (gunshot wound and assault) were significantly (P < 0.01) more likely to have positive admission toxicology screens (76% v 41%), drug screens (62% v 14%), and intoxication screens (72% v 34%). Rehabilitation outcome comparisons between those with positive and negative screens revealed similar length of stay, admission and discharge Functional Independence Measure (FIM) scores, FIM change scores, and FIM efficiency scores. This study has important implications with regard to substance abuse issues and their impact on traumatic spinal cord injury outcome, which may assist in better targeting prevention.     

基于VFSS/MBS的吞咽困难饮食调整策略

饮食调整是一种吞咽困难康复常用而又重要的干预手段。根据电视X线透视吞咽功能研究／改良吞钡造影，可以明确患者能够适应的固体／液体食物种类、适宜的每口摄入量和吞咽时有效的姿势调整方法，以确定安全、有效的吞咽困难饮食调整策略，尽量保证经口进食，促进患者吞咽功能的康复。     

Complications following spinal cord injury: occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation.

OBJECTIVE: To assess the occurrence and risk factors for complications following spinal cord injury during and after inpatient rehabilitation. DESIGN: Multicentre longitudinal study. SUBJECTS: A total of 212 persons with a spinal cord injury admitted to specialized rehabilitation centres. METHODS: Assessments at the start of active rehabilitation (n=212), 3 months later (n=143), at discharge (n=191) and 1 year after discharge (n=143). RESULTS: Multi-level random coefficient analyses revealed that complications were common following spinal cord injury. Most subjects reported neurogenic and musculoskeletal pain, or had spasticity at each assessment. During the year after discharge, complications remained common: urinary tract infections and pressure sores affected 49% and 36% of the population, respectively. The degree of pain decreased, whereas the degree of spasticity increased significantly during inpatient rehabilitation. Overall, increased age, increased body mass index, traumatic lesion, tetraplegia, and complete lesion all increased the risk of complications. CONCLUSION: Complications are common following spinal cord injury. They need specific attention after discharge from inpatient rehabilitation and within subpopulations.     

Post-acute care referral and inpatient rehabilitation admission criteria for persons with brain injury across two Canadian provinces

Purpose: Investigate health care providers’ perceptions of referral and admission criteria to brain injury inpatient rehabilitation in two Canadian provinces.

Methods: Health care providers (n?=?345) from brain injury programs (13 acute care and 16 rehabilitation facilities) participated in a cross-sectional web-based survey. The participants rated the likelihood of patients (traumatic brain injury and cerebral hypoxia) to be referred/admitted to rehabilitation and the influence of 19 additional factors (e.g., tracheostomy). The participants reported the perceived usefulness of referral/admission policies and assessment tools used.

Results: Ninety-one percent acute care and 98% rehabilitation participants reported the person with traumatic brain injury would likely or very likely be referred/admitted to rehabilitation compared to respectively 43% and 53% for the patient with hypoxia. Two additional factors significantly decreased the likelihood of referral/admission: older age and the combined presence of minimal learning ability, memory impairment and physical aggression. Some significant inter-provincial variations in the perceived referral/admission procedure were observed. Most participants reported policies were helpful. Similar assessment tools were used in acute care and rehabilitation.

Conclusions: Health care providers appear to consider various factors when making decisions regarding referral and admission to rehabilitation. Variations in the perceived likelihood of referral/admission suggest a need for standardized referral/admission practices.

• Implications for Rehabilitation

• Various patient characteristics influence clinicians’ decisions when selecting appropriate candidates for inpatient rehabilitation.

• In this study, acute care clinicians were less likely to refer patients that their rehabilitation counter parts would likely have admitted and a patient with hypoxic brain injury was less likely to be referred or admitted in rehabilitation than a patient with a traumatic brain injury.

• Such discrepancies suggest that policy-makers, managers and clinicians should work together to develop and implement more standardized referral practices and more specific admission criteria in order to ensure equitable access to brain injury rehabilitation services.

     

针刺结合神经肌肉电刺激对脑卒中后咽期吞咽障碍的影响

目的:观察针刺结合神经肌肉电刺激对脑卒中后咽期吞咽障碍患者康复的影响。方法:按随机数字表法将40例脑卒中患者分为2组各20例,对照组给予常规药物治疗、吞咽功能训练和神经肌肉电刺激,观察组在对照组的基础上给予针刺治疗。治疗前后采用表面肌电分析(记录sEMG最大波幅)、透视吞咽功能检查(VFSS)对患者吞咽功能进行评价。结果:治疗20d后,2组患者的sEMG最大波幅、VFSS总评分及咽期VFSS评分明显高于治疗前(P0.05),且观察组更高于对照组(P0.05)。结论:针刺结合神经肌肉电刺激能明显提高脑卒中后咽期吞咽障碍患者的康复效果。     

An Italian survey of traumatic spinal cord injury. The Gruppo Italiano Studio Epidemiologico Mielolesioni study

OBJECTIVE: To describe the etiology, clinical presentation, complications, outcome indicators, and links between emergency and acute intervention and rehabilitation of patients with traumatic spinal cord injury (SCI). DESIGN: Multicenter prospective study involving patients with SCI discharged, after rehabilitative care, between February 1, 1997, and January 31, 1999. SETTING: Thirty-two Italian hospitals involved in SCI rehabilitation. PARTICIPANTS: Six hundred eighty-four patients with traumatic SCI on their first admission to a rehabilitation center. INTERVENTIONS: Not applicable. Main Outcome Measures: Neurologic improvement (NI), bladder autonomy, feelings of dependency, and destination were evaluated on discharge. Pressure ulcers on admission, time from injury to admission, and length of stay (LOS) were considered as indirect measures of the effectiveness of the health system. RESULTS: Traumatic etiology had a male-to-female ratio of 4:1 (548:136). Collision on the road was the main cause of traumatic injury (53.8%). Mean time from injury to admission was 36.8 days; 126 patients (18%) were admitted within the first week after injury. Mean LOS was 135.5 days. In 184 patients (26.9%), a pressure ulcer was present on admission. On discharge, NI was recorded in 179 patients (26.2%), whereas 446 (65%) and 418 (61%) had bladder and bowel autonomy, respectively, and 560 (81.9%) returned home. In the multivariate analysis, independent variables predicting poor outcome (NI, feelings of dependency, sphincter autonomy, discharge to home, LOS) were related both to the lesion (completeness, cervical involvement) and to the indicators of health service organization (time from injury to admission, complications on admission and during stay). CONCLUSIONS: Our focus on the etiology of traumatic SCI showed that efforts should be made to prevent collisions on the road. Our study also highlights problems in the comprehensive management of patients with SCI in Italy. Better organization could help reduce the time from injury to admission, the number of complications on admission, and LOS, and it could help improve rehabilitation outcome.     

Cervical spine clearance and neck extension during percutaneous tracheostomy in trauma patients

INTRODUCTION: The lack of cervical spine clearance and inability to extend the neck are assumed to be relative contraindications for percutaneous tracheostomy. OBJECTIVE: To determine the necessity of cervical spine clearance and neck extension in trauma patients receiving percutaneous tracheostomy. DESIGN: Prospective analysis of case series from August 1, 1995 to August 31, 1998. SETTING: A university-based Level I trauma center. PATIENTS: A total of 88 consecutive trauma patients receiving percutaneous tracheostomy. Patients were divided into two groups based on the radiographic or clinical status of their cervical spine: cleared and noncleared. RESULTS: The overall success and complication rate were 99% (87/88) and 11% (10/88), respectively. There were no procedure-related deaths. The cleared group consisted of 60 patients; three patients in this group who had "bull" or "thick" necks did not have full neck extension during percutaneous tracheostomy. The noncleared group consisted of 28 patients, 13 of which had known cervical spine fractures; 27 noncleared patients were maintained in the neutral position (no extension) during percutaneous tracheostomy, whereas one patient with low suspicion of spinal injury was partially extended. Of the 13 patients with cervical spine fractures, six patients had been stabilized with a halo or operative fixation, and seven patients were stabilized with a cervical collar at the time of percutaneous tracheostomy. The success rate was 100% (60/60) for the cleared group compared with 96% (27/28) for the noncleared group (p > .05). The complication rate was 13% (8/60) for the cleared group compared with 7.1% (2/28) for the noncleared group (p > .05). We had a 100% success rate and no complications in the seven patients with cervical spine injury who were stabilized with a cervical collar. No patient had spinal cord injury caused by percutaneous tracheostomy. CONCLUSION: Percutaneous tracheostomy can be safely performed in trauma patients without cervical spine clearance and neck extension, including patients with stabilized cervical spine or spinal cord injury.     

Traumatic brain injury is under-diagnosed in patients with spinal cord injury.

OBJECTIVE: To investigate the occurrence and severity of traumatic brain injury in patients with traumatic spinal cord injury. DESIGN: Cross-sectional study with prospective neurological, neuropsychological and neuroradiological examinations and retrospective medical record review. PATIENTS: Thirty-one consecutive, traumatic spinal cord injury patients on their first post-acute rehabilitation period in a national rehabilitation centre. METHODS: The American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury were applied. Assessments were performed with neurological and neuropsychological examinations and magnetic resonance imaging 1.5T. RESULTS: Twenty-three of the 31 patients with spinal cord injury (74%) met the diagnostic criteria for traumatic brain injury. Nineteen patients had sustained a loss of consciousness or post-traumatic amnesia. Four patients had a focal neurological finding and 21 had neuropsychological findings apparently due to traumatic brain injury. Trauma-related magnetic resonance imaging abnormalities were detected in 10 patients. Traumatic brain injury was classified as moderate or severe in 17 patients and mild in 6 patients. CONCLUSION: The results suggest a high frequency of traumatic brain injury in patients with traumatic spinal cord injury, and stress a special diagnostic issue to be considered in this patient group.     

Clinical trial of acupuncture for patients with spinal cord injuries

OBJECTIVE: To examine whether electrical acupuncture therapy through adhesive surface electrodes and concomitant auricular acupuncture therapy could improve the neurologic or functional recovery in acute traumatic spinal cord injury patients. DESIGN: A total of 100 acute traumatic spinal cord injury patients with American Spinal Injury Association (ASIA) impairment grading of A and B were recruited into this study. They were randomly divided into the acupuncture and control groups. In the acupuncture group, electrical acupuncture therapy via the adhesive surface electrodes were applied to the bilateral Hou Hsi (SI3) and Shen Mo (B62) acupoints. In auricular acupuncture, four acupoints related to the spinal cord were selected for stimulation at the antihelix, helix, and lower portion of the ear-back areas. Acupuncture therapy was initiated early in the emergency room setting or soon after spinal surgical intervention. Rehabilitation therapy was also provided to the patients during acupuncture therapy. In the control group, only rehabilitation therapy was provided to the patients. Neurologic and functional scores were assessed during the time of admission, hospital discharge, and 1-yr postinjury follow-up. RESULTS: There were significant improvements in neurologic (sensory and motor), functional, and FIM scores in the acupuncture group compared with the initial admission period when assessed during the time of hospital discharge and the 1-yr postinjury follow-up. A greater percentage of patients in the acupuncture group recovered to a higher ASIA impairment grading. CONCLUSION: The use of concomitant auricular and electrical acupuncture therapies, when implemented early in acute spinal cord injury, can contribute to significant neurologic and functional recoveries.