Manual stimulation of reflex voiding after spinal cord injury

Thirty-four urodynamic studies were performed in 20 patients with spinal cord injury (SCI) to determine the most effective triggering mechanism for reflex voiding. The studies were performed at a time when the patient was normally scheduled for catheterization, which avoided stimulation of the detrusor and sphincter by bladder filling via a catheter. The three methods chosen were used in a random sequence. Suprapubic tapping and jabbing were equally effective in producing a rise in detrusor pressure, and the sphincter responses were almost identical. Cutaneous stimulation of the thigh rarely produced any change in detrusor and sphincter activity. When detrusor contractions were produced, a dyssynergic sphincter response prevented voiding in 46% of the studies; however, voiding always occurred when the sphincters were either coordinated or showed no change. Both tapping and jabbing were more effective as the time from injury increased, which reflects the natural recovery from spinal shock.     

Knee kinetics during functional electrical stimulation induced cycling in subjects with spinal cord injury: a preliminary study

The purpose of this preliminary study was to describe pedal effectiveness parameters and knee-joint reaction forces generated by subjects with chronic spinal cord injury (SCI) during functional electrical stimulation (FES)-induced bicycling. Three male subjects (age 33-36 years old), who were post-traumatic SCI (ASIA-modified level A, level T4-C5) and enrolled in an FES rehabilitation program, signed informed consent forms and participated in this study. Kinematic data and pedal forces during bicycling were collected and effective force, knee-joint reaction forces, knee generalized muscle moments, and knee-joint power and work were calculated. There were three critical findings of this study: 1) pedaling effectiveness was severely compromised in this subject population as indicated by a lack of overall positive crank work; 2) knee-joint kinetics were similar in magnitude to data reported for unimpaired individuals pedaling at higher rates and workloads, suggesting excessive knee-joint loading for subjects with SCI; and 3) shear reaction forces and muscle moments were opposite in direction to data reported for unimpaired individuals, revealing an energetically unfavorable knee stabilizing mechanism. The critical findings of this study suggest that knee-joint kinetics may be large enough to produce a fracture in the compromised lower limbs of individuals with SCI.     

Enhanced stretch reflex excitability of the soleus muscle in persons with incomplete rather than complete chronic spinal cord injury

OBJECTIVE: To compare excitabilities of spinal stretch reflex among clinically complete spinal cord injury (SCI), incomplete SCI, elderly healthy, and young healthy subjects. DESIGN: Case comparison. SETTING: Research laboratory. PARTICIPANTS: Volunteer sample of 12 complete SCI, 10 incomplete SCI, 10 elderly, and 11 young subjects. INTERVENTION: Mechanically induced stretch reflex, H-reflex, and M response in electromyographic activity of the soleus muscle were recorded in all subjects. MAIN OUTCOME MEASURES: Absolute peak-to-peak stretch reflex amplitude and maximum H-reflex (Hmax), and those values relative to the maximum M response (Mmax) amplitude (relative peak-to-peak stretch reflex amplitude) and H/M ratio. RESULTS: Both the absolute and relative peak-to-peak stretch reflex amplitudes showed the greatest values in incomplete SCI among the 4 groups. Although absolute and relative peak-to-peak stretch reflex amplitudes of the incomplete SCI group were greater than those of the complete SCI group, the H/M ratios of both groups were comparable, and were greater than those of the younger and elderly groups. CONCLUSIONS: The results suggest that the greater absolute and relative peak-to-peak stretch reflex amplitudes of incomplete SCI were mostly due to the greater maximum motor potential (Mmax), while the elevated spinal motoneuronal excitability shown by the increased H/M ratio was maintained in the chronic stage after both complete and incomplete SCIs.     

Continuous monitoring of detrusor pressure in patients with a reflex urinary bladder after spinal cord injury

In spinal cord injury, the detrusor pressure, as a parameter of urinary bladder dysfunction, is related to incontinence and renal complications. In order to determine the intraindividual variation of maximum pressure and duration of detrusor contractions, in patients with a spinal reflex bladder, the detrusor pressure was registered during 24 hours of physiological filling in 16 patients. Between the bladder contractions the detrusor pressure was low in all patients, indicating high bladder complicance. During contractions the maximum detrusor pressure and its duration varied both inter- and intraindividually. In individual patients, however, mean values during the initial 12 hours correlated with mean values during the final 12 hours. Thus, mean values of a series of contractions appear to be characteristic of each patient and useful in describing the voiding pressure in spinal reflex bladder.     

Reduced sympathetic skin response in the isolated spinal cord of subjects with spinal cord injury

OBJECTIVE: To compare the excitability of the sympathetic skin response (SSR) between subjects with spinal cord injury (SCI) and healthy controls with intact supraspinal connection. DESIGN: Cross-sectional survey. SETTING: Referral center. PARTICIPANTS: A total of 37 men with traumatic neurologically complete SCI (26 with tetraplegia, 11 with paraplegia) and history of autonomic dysreflexia were included. Twenty age-matched healthy male controls were recruited as the control group. Subjects with SCI were at the mean age +/- standard deviation of 36.5+/-11.0 years (range, 20.1-61.3 y) and the mean injury duration was 11.3+/-9.3 years (range, 1.0-38.1 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The SSR tests were grouped into 3 test sets according the stimulation and recording sites: (1) right supraorbital nerve stimulation with left hand recording (SH set); (2) right supraorbital nerve stimulation and left foot recording (SF set); and (3) right posterior tibial nerve stimulation and left foot recording (TF set). RESULTS: In patients with tetraplegia (n=26), none showed positive SSR in the SH or the SF set, and only 5 (19.2%) showed a positive SSR in the TF set. In subjects with paraplegia (n=11), the positive response rates of SSR were 72.7% for the SH set, 0% for the SF set, and 9.1% for the TF set. Electric stimulation at high intensity (100 mA for 1 ms) was required to elicit SSR for the TF set in the patients with SCI. The SSR amplitudes in the SH and TF sets were smaller in subjects with SCI than those in controls (SH set, P=.004; TF set, P<.001). The SSR latency in the SH set was longer in patients with SCI (P=.04), whereas the SSR latency in the TF set tended to be shorter in subjects with SCI (P=.09). CONCLUSIONS: The excitability of SSR was reduced in an isolated spinal cord. This suggests that excitability of sympathetic sudomotor response in subjects with an isolated spinal cord is lower than in healthy controls.     

步行训练对外伤性脊髓损伤患者骨量丢失的影响

目的:通过观察骨密度和骨代谢相关指标的变化来评价步行训练防治外伤性脊髓损伤患者骨量丢失的临床疗效并探讨其作用机制。方法:选取23例外伤性脊髓损伤合并骨量丢失患者,随机分为观察组12例和对照组11例。2组均进行常规康复训练,观察组在此基础上进行步行训练。2组均每日治疗1次,连续治疗60d。治疗前、治疗1个月、治疗2个月分别测定患者的腰椎和股骨骨密度、抗酒石酸酸性磷酸酶5b(TRACP5b)、骨碱性磷酸酶(BALP)、25羟基维生素D[25(OH)D]、血钙、血磷、血清碱性磷酸酶(ALP)的变化情况。结果:治疗2个月后,观察组的TRACP5b治疗前后差异无统计学意义,对照组治疗2个月后TRACP5b值较治疗前明显升高(P0.05),且观察组低于对照组(P0.05)。治疗1及2个月后,2组患者的腰4椎体、腰1-腰4椎体骨密度均呈下降趋势,组内和组间比较,其差异并无统计学意义。治疗1及2个月后,2组患者的股骨颈、股骨全部骨密度均呈下降趋势(均P0.05),对照组治疗2个月后和治疗前相比明显下降(均P0.05)。治疗后1、2个月后,BALP、25(OH)D、血钙、血磷、ALP 5个指标组内及组间比较差异均无统计学意义。结论:步行训练能减轻外伤性脊髓损伤患者股骨颈和股骨全部骨密度下降的程度,但对损伤平面以下不同部位骨密度的影响不同,其作用机制可能和抑制骨吸收有关。     

Functional neuromuscular stimulation in spinal cord injury

With recent advances in clinical medicine and biomedical engineering, functional neuromuscular stimulation (FNS) can now be added to the psychiatric armamentarium to decrease the debilitating effects of traumatic spinal cord injury. In this article, the components of FNS systems and their evolution in design are presented. The clinical implications of FNS are discussed with respect to upper and lower extremities and bladder applications, and perspectives on future developments and directions are reviewed.     

Circulatory hypokinesis and functional electric stimulation during standing in persons with spinal cord injury.

OBJECTIVE: To evaluate the effects of functional electric stimulation (FES) of lower limb muscles during 30 minutes of upright standing on the central and peripheral hemodynamic response in persons with spinal cord injury (SCI). DESIGN: A repeated-measure design. Subjects were used as their own control and underwent 2 testing protocols of FES-augmented standing (active standing) and non-FES standing (passive standing). SETTING: Rehabilitation hospital. PARTICIPANTS: Fourteen individuals with SCI (7 with tetraplegia, 7 with paraplegia). INTERVENTIONS: During active standing, FES was administered to 4 muscle groups of each leg in an overlapping fashion to produce a pumping mechanism during standing. During passive standing, subjects stood for 30 minutes using a standing frame with no FES intervention. MAIN OUTCOME MEASURES: Central hemodynamic responses of stroke volume, cardiac output, heart rate, arterial blood pressure, total peripheral resistance (TPR), and rate pressure product (RPP) were evaluated by impedance cardiography. All measurements were performed during supine and sitting positions before and after standing, and during 30 minutes of upright standing. RESULTS: Comparisons between the groups with paraplegia and tetraplegia showed a significant increase in heart rate in the paraplegics after 30 minutes of active standing. During active standing, paraplegics' heart rate increased by 18.2% (p = .015); during passive standing, it increased by 6% (p = .041). TPR in the tetraplegics significantly (p = .003) increased by 54% when compared with the paraplegics during passive standing. Overall, the tetraplegic group had a significantly lower systolic blood pressure (p = .013) and mean arterial pressure (p = .048) than the paraplegics during passive standing. These differences were not detected during active standing. When data were pooled from both groups and the overall groups response to active and passive standing were compared, the results showed that cardiac output, stroke volume, and blood pressure significantly decreased (p < .05) during 30 minutes of passive standing, whereas TPR significantly increased (p < .05). All of the hemodynamic variables were maintained during 30 minutes of active standing, and there were increases in RPP and heart rate after 30 minutes of active standing. CONCLUSION: FES of the lower extremity could be used by persons with SCI as an adjunct during standing to prevent orthostatic hypotension and circulatory hypokinesis. This effect may be more beneficial to those with tetraplegia who have a compromised autonomic nervous system and may not be able to adjust their hemodynamics to the change in position.     

A comparison of shoulder joint forces during ambulation with crutches versus a walker in persons with incomplete spinal cord injury

OBJECTIVE: To compare 3-dimensional (3D) shoulder joint reaction forces and stride characteristics during bilateral forearm crutches and front-wheeled walker ambulation in persons with incomplete spinal cord injury (SCI). DESIGN: Cross-sectional cohort study. SETTING: Biomechanics laboratory. PARTICIPANTS: Fourteen adult volunteers with incomplete SCI recruited from outpatient rehabilitation hospital services. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Peak force, rate of loading, and force-time integral were compared for each component of the net 3D shoulder joint reaction force during ambulation with crutches and a walker. Stride characteristics were also compared between assistive device conditions. RESULTS: The largest weight-bearing force was superiorly directed, followed by the posterior force. The superior joint force demonstrated a significantly higher peak and rate of loading during crutch walking (48.9N and 311.6N/s, respectively, vs 45.3N and 199.8N/s, respectively). The largest non-weight-bearing force was inferiorly directed with a significantly greater peak occurring during crutch ambulation (43.2N vs 23.6N during walker gait). Walking velocity and cadence were similar; however, stride length was significantly greater during crutch walking (62% vs 58% of normal). CONCLUSIONS: Shoulder joint forces during assisted ambulation were large. Crutch use increased the superior force but did not increase walking velocity.     

Changes in physical capacity during and after inpatient rehabilitation in subjects with a spinal cord injury

OBJECTIVE: To assess changes in physical capacity and its determinants in persons with a spinal cord injury. DESIGN: Prospective cohort study. Measurements at the start of active rehabilitation (t1), 3 months later (t2), at discharge (t3), and 1 year after discharge (t4). SETTING: Eight rehabilitation centers in The Netherlands. PARTICIPANTS: A total of 186 subjects at t1 and 123 subjects at t4. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak aerobic power output (POpeak), peak oxygen uptake (V(O2)peak), muscle strength of the upper extremity (manual muscle test, handheld dynamometry), and respiratory function (forced expiratory flow per second, forced vital capacity). RESULTS: Random coefficient analysis demonstrated that the POpeak, V(O2)peak, strength, and respiratory function improved during inpatient rehabilitation, and that V(O2)peak, strength, and respiratory function continued to improve after discharge. Age, sex, and level and completeness of lesion were determinants of the change in components of physical capacity. CONCLUSIONS: Physical capacity improves during inpatient rehabilitation, and some components continue to improve after discharge. Subpopulations have a different level of (change in) physical capacity. The components of physical capacity are related; intervention studies are needed to confirm whether training 1 component could improve another component.     

Balance and ambulation improvements in individuals with chronic incomplete spinal cord injury using locomotor training-based rehabilitation

Harkema SJ, Schmidt-Read M, Lorenz DJ, Edgerton VR, Behrman AL. Balance and ambulation improvements in individuals with chronic incomplete spinal cord injury using locomotor training–based rehabilitation.ObjectiveTo evaluate the effects of intensive locomotor training on balance and ambulatory function at enrollment and discharge during outpatient rehabilitation after incomplete SCI.DesignProspective observational cohort.SettingSeven outpatient rehabilitation centers from the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN).ParticipantsPatients (N=196) with American Spinal Injury Association Impairment Scale (AIS) grade C or D SCI who received at least 20 locomotor training treatment sessions in the NRN.InterventionsIntensive locomotor training, including step training using body-weight support and manual facilitation on a treadmill followed by overground assessment and community integration.Main Outcome MeasuresBerg Balance Scale; Six-Minute Walk Test; 10-Meter Walk Test.ResultsOutcome measures at enrollment showed high variability between patients with AIS grades C and D. Significant improvement from enrollment to final evaluation was observed in balance and walking measures for patients with AIS grades C and D. The magnitude of improvement significantly differed between AIS groups for all measures. Time since SCI was not associated significantly with outcome measures at enrollment, but was related inversely to levels of improvement.ConclusionsSignificant variability in baseline values of functional outcome measures is evident after SCI in individuals with AIS grades C and D and significant functional recovery can continue to occur even years after injury when provided with locomotor training. These results indicate that rehabilitation, which provides intensive activity-based therapy, can result in functional improvements in individuals with chronic incomplete SCI.     

Improved intralimb coordination in people with incomplete spinal cord injury following training with body weight support and electrical stimulation

BACKGROUND AND PURPOSE: Limb coordination is an element of motor control that is frequently disrupted following spinal cord injury (SCI). The authors assessed intralimb coordination in subjects with SCI following a 12-week program combining body weight support, electrical stimulation, and treadmill training. SUBJECTS: Fourteen subjects with long-standing (mean time post-SCI=70 months, range=12-171 months), incomplete SCI participated. Three subjects without SCI provided data for comparison. METHODS: A vector-based technique was used to assign values to the frame-by-frame changes in hip/knee angle, and vector analysis techniques were used to assess how closely the hip/knee angles of each step cycle resembled those of every other step cycle. Overground and treadmill walking speeds also were measured. RESULTS: Following training, 9 of the 14 subjects with SCI demonstrated greater intercycle agreement. Mean overground and treadmill walking speeds improved (84% and 158%, respectively). DISCUSSION AND CONCLUSION: The intervention used in this study is based on our current understanding of the role of afferent input in the production of walking. Although the study sample was small and there was no control group, results suggest that training may improve intralimb coordination in people with SCI.     

Reliability of surface electromyographic measurements from subjects with spinal cord injury during voluntary motor tasks

In this study, the reliability of surface electromyographic data (root-mean-square) for volitional motor tasks drawn from a standardized protocol was assessed. For each motor task, 5 s epochs of data were analyzed with a new method to generate a measure called the voluntary response index (VRI). The VRI consists of two components, magnitude and similarity index (SI), that were separately analyzed for repeatability. We examined three repetitions of each of 10 volitional motor tasks in 69 subjects with spinal cord injury (American Spinal Injury Association [ASIA] Impairment Scale [AIS], classifications C and D: 34 AIS-C and 35 AIS-D) for short-term (within-day) reliability. In 6 of the 69 subjects (3 each, AIS-C and AIS-D), the entire study was repeated after 1 week and results were assessed for intermediate-term (1 week apart) reliability. The reliability of the method for voluntary motor tasks was assessed by intraclass correlation coefficient (ICC), analysis of variance, coefficient of variance, and Pearson's correlation. Good reliability was found for magnitude (ICC = 0.71-0.99, Pearson's r = 0.77-0.99) and for SI (ICC = 0.65-0.96, Pearson's r = 0.72-0.93) for three repeated tests (within-day). Significant difference was found for studies completed 1 week apart for magnitude (p = 0.02) but not for SI (p = 0.57). In addition, SI showed less variation than magnitude (p < 0.001). No significant difference of magnitude and SI between tasks was observed.     

Comparison of soleus H-reflex modulation after incomplete spinal cord injury in 2 walking environments: treadmill with body weight support and overground

Phadke CP, Wu SS, Thompson FJ, Behrman AL. Comparison of soleus H-reflex modulation after incomplete spinal cord injury in 2 walking environments: treadmill with body weight support and overground.

Objective

To investigate a walking environment effect on soleus H-reflex modulation during walking in persons with motor incomplete spinal cord injury (SCI) and noninjured controls.

Design

Pretest and posttest repeated-measures quasi-experimental controlled design.

Setting

Locomotor training laboratory.

Participants

Eight adults with incomplete SCI and 8 noninjured age- and speed-matched controls.

Intervention

Walking overground with a customary assistive device and brace at a self-selected, comfortable walking speed was compared with walking on treadmill with 40% body weight support (BWS) and manual trainers for leg and trunk movement guidance.

Main Outcome Measure

Mean soleus H-reflex amplitude (H/M ratio) was recorded during midstance and midswing phases of walking.

Results

The H/M ratio was 33% smaller in stance phase (P=.078) and 56% smaller in the swing phase (P=.008) of walking on the treadmill with BWS and manual assistance compared with overground in the incomplete SCI group. The H/M ratio in the incomplete SCI group was significantly greater compared with noninjured controls in the stance and swing phases of overground walking (P=.001, P=.007, respectively). Soleus H-reflex modulation in the 2 walking environments did not differ significantly in the noninjured population.

Conclusions

Training walking on a treadmill with BWS and manual assistance to approximate the kinematics and spatiotemporal pattern of walking may be a more optimal environment to aid in normalizing reflex modulation after incomplete SCI when compared with conventional gait training overground.     

脊髓损伤患者双下肢神经肌肉的电生理特征

目的:采用神经传导测定及肌电图观察脊髓损伤(SCI)患者双下肢神经肌肉电生理变化,为脊髓损伤后双下肢神经肌肉功能判断提供依据。方法:19例脊髓损伤患者,采用常规神经传导检测方法测定双胫、腓总神经运动及感觉传导,分析末端潜伏期、动作电位波幅及传导速度。采用同心圆针电极检测双侧胫前肌、腓肠肌、股四头肌及L4—S1脊旁肌自发肌电活动(SA)。结果:①神经传导特征:94.7%患者运动传导异常,表现为单纯复合肌肉动作电位(CMAP)波幅降低、波幅降低伴潜伏期延长、动作电位缺失三种类型;15.8%的患者同时伴有感觉传导异常,表现为波幅降低、传导速度减慢或动作电位缺失;②胫神经:单纯运动传导异常占47.4%,运动与感觉传导均异常占10.5%;运动传导均表现为双侧异常(动作电位缺失、波幅减低和/或潜伏期延长);感觉传导表现为单侧传导速度减慢和/或波幅降低;③腓总神经:单纯运动异常占78.9%,运动与感觉均受累为15.8%;运动传导双侧异常为84.2%(动作电位缺失和/或波幅降低),单侧异常为10.5%(波幅降低和/或潜伏期延长);感觉传导异常为双侧或单侧动作电位缺失、传导速度降低和波幅降低(15.8%);④胸腰段SCI的胫、腓神经运动传导异常显著高于颈段SCI(腓神经为100%:85.7%,胫神经为66.7%:42.9%)。⑤肌肉自发电活动:所有患者双下肢肌肉及脊旁肌均见不同程度的自发电活动,包括纤颤电位、正锐波。结论:脊髓损伤后双下肢电生理主要表现为运动神经轴索性损害及肌肉异常自发电活动,肌肉异常自发电活动与下肢周围神经电生理改变无关;胸腰段脊髓损伤下肢周围神经传导异常比例高于颈段脊髓损伤。     

Total body water and its distribution in men with spinal cord injury

During the first months after spinal cord injury there is a drastic loss in body weight. Total body water (TBW) and extracellular water (ECW) were determined in 12 normal healthy men, in 22 paraplegic men and in 23 quadriplegic men. TBW was decreased in both groups of patients, paralleling the loss in body weight, though not totally accounting for the weight loss. ECW was decreased in absolute terms but increased in relation to body weight and height. The amount of intracellular water, obtained by subtracting ECW from TBW, was decreased. This study provides a quantitative estimation of the reduction in body cell mass following spinal cord injury and reveals an expansion of the extracellular space. The mechanism and functional significance of this expansion are not clear at this time.     

Functional magnetic stimulation of the colon in persons with spinal cord injury

OBJECTIVE: To evaluate the usefulness of functional magnetic stimulation (FMS) as a noninvasive method to stimulate the colon in individuals with spinal cord injury (SCI). DESIGN: A prospective before-after trial consisting of 2 protocols. SETTING: FMS laboratories of 2 SCI centers. PARTICIPANTS: Two able-bodied men and 13 men with SCI levels ranging from C3 to L1. Protocol 1 consisted of 9 subjects, 2 of whom were excluded from the analysis. Protocol 2 consisted of 4 subjects. INTERVENTION: Commercially available magnetic stimulators with round magnetic coils (MCs) were used. Protocol 1 measured the effects of FMS on rectal pressure by placing the MC on the transabdominal and lumbosacral regions. Protocol 2 consisted of a 5-week stimulation period to investigate the effects of FMS on total and segmental colonic transit times (CTTs). MAIN OUTCOME MEASURE: An increase in rectal pressure and a decrease in CTT by magnetic stimulation. RESULTS: Data were averaged and the standard error of the mean was calculated. Statistically significant changes in rectal pressure and CTT were also measured. Rectal pressures increased from 26.7 +/- 7.44cmH(2)O to 48.0 +/- 9.91cmH(2)O, p =.0037, with lumbosacral stimulation, and from 30.0 +/- 6.35cmH(2)O to 42.7 +/- 7.95cmH(2)O, p =.0015, with transabdominal stimulation. With FMS, the mean CTT decreased from 105.2 to 89.4 hours, p =.02. CONCLUSION: FMS is able to stimulate the colon and reduce CTT. FMS is a noninvasive, technological advancement for managing neurogenic bowel in patients with SCI.     

Bronchodilator responses to metaproterenol sulfate among subjects with spinal cord injury

A previous study using spirometric methods demonstrated that 42% of subjects with tetraplegia experienced significant bronchodilation following inhalation of metaproterenol sulfate (MS). Comparative studies involving subjects with paraplegia were not performed and none has been performed in this population using body plethysmography, a more sensitive method used to assess airway responsiveness. Stable subjects with tetraplegia (n = 5) or paraplegia (n = 5) underwent spirometry and determination of specific airway conductance (sGaw) by body plethysmography at baseline and 30 minutes after nebulization of MS (0.3 mL of a 5% solution). Among subjects with tetraplegia, inhaled MS resulted in significant increases in spirometric indices and sGaw. Among subjects with paraplegia, only sGaw increased significantly, although this increase was considerably less than that seen in subjects with tetraplegia. Our findings indicate that subjects with tetraplegia exhibit greater bronchodilation in response to inhaled MS than do subjects with paraplegia and that sGaw measurements may confer greater sensitivity for assessing bronchodilator responsiveness in tetraplegia.     

Remote monitoring of sitting behavior of people with spinal cord injury

The clinical assessment of risk factors leading to pressure sores is normally undertaken in a hospital clinic. However, knowledge of the sitting behavior of the patient outside the clinic may more realistically and comprehensively identify these factors. Many patients, for example, are thought to sit habitually with more pressure on one buttock than the other, and this may significantly increase the risk. This sitting asymmetry may be due to the layout of a work area, the home, or a simple habit. Furthermore, busy wheelchair users may be too preoccupied to remember to reposition themselves regularly but may do so frequently at less hectic times. The applicants have developed a miniature remote pressure logger, which keeps a record of the sitting behavior of the wheelchair user. This study examines the feasibility of using the device for long-term monitoring of sitting pressure distributions during daylong wheelchair activities.     

Physiopathologic aspects and nursing care in the rehabilitation of subjects with spinal cord injury

Spinal cord injury can cause neurological damage such as alterations in the motor, sensitive and autonomic function. In this paper, details of clinical complications such as PVT, infection, respiratory insufficiency, pressure ulcers, autossomic disreflection, orthostatic hypotension, sphincteral-vesical and intestinal disfunctions, are related. And will also present prophylactic and therapeutic nursing care interventions designed for the well-being and improvement in life quality for patients.