Contractures complicating spinal cord injury: incidence and comparison between spinal cord centre and general hospital acute care

One hundred and eighty-one spinal cord injured patients admitted to the Rehabilitation Institute of Chicago after acute care following a spinal cord injury were studied. The presence or absence of contractures as well as significant abnormalities with loss of range of motion greater than 15% was recorded. Patients were either admitted from general hospitals or the acute care unit of our spinal centre, Northwestern Memorial Hospital. Patients treated in the general hospitals had a statistically significant increased incidence of contractures compared to spinal centre patients. Patients treated in the spinal centre were transferred to the rehabilitation hospital sooner post injury. An increased time from onset to rehabilitation admission correlated with a statistically significant increased incidence of contractures. Tetraplegic patients had a statistically significant increase over paraplegic patients and were more likely to have contractures of several upper extremity joints. Contracture development was not related to fractures of the extremities. This evidence further supports the need for spinal cord centres and provides data on the incidence of contractures in spinal cord injured patients which has not been reported previously.     

Benefits of rehabilitation for traumatic spinal cord injury. Multivariate analysis in 711 patients

The functional outcomes of 711 patients with traumatic spinal cord injuries who were admitted to a rehabilitation hospital during an eight-year period were studied. The modified Barthel index, a 100-point scale, was used to assess ability to perform self-care and mobility skills at rehabilitation admission and discharge. There were statistically significant improvements in self-care and mobility subscores of the modified Barthel index. Mean total modified Barthel index scores increased from 13.8 at admission to 46.1 at discharge for patients with quadriplegia, and from 37.7 to 74.4 for patients with paraplegia. Functional gains made by patients with incomplete spinal lesions were greater than those made by patients with complete lesions. This study documents improvement in ability to perform self-care and mobility skills among patients with spinal cord injuries who participate in comprehensive rehabilitation.     

Functional outcome following spinal cord injury. A comparison of specialized spinal cord injury center vs general hospital short-term care

The functional outcomes of 185 patients with spinal cord injuries undergoing rehabilitation who were initially treated in a specialized short-term care unit (center patients) were compared with those of 153 patients initially treated in general hospitals (noncenter patients). After stabilization, all patients were admitted to the Rehabilitation Institute of Chicago (Ill) and received the same rehabilitation program. The groups were comparable in terms of demographic, injury, and medical characteristics at the time of rehabilitation center admission, but the duration from injury to rehabilitation was more than twice as long for noncenter patients. While center patients were discharged from the rehabilitation center at equivalent functional skill levels, their daily rate of functional gains during the rehabilitation center stay was significantly greater than that of noncenter patients although the length of stay at the rehabilitation center was comparable for the two groups. These results support the practice of specialized short-term spinal cord injury care as a means of enhancing rehabilitation outcome.     

Application of a paraplegic gait orthosis in thoracolumbar spinal cord injury

Paraplegic gait orthosis has been shown to help paraplegic patients stand and walk, although this method cannot be individualized for patients with different spinal cord injuries and functional recovery of the lower extremities. There is, however, a great need to develop individualized paraplegic orthosis to improve overall quality of life for paraplegic patients. In the present study, 36 spinal cord(below T4) injury patients were equally and randomly divided into control and observation groups. The control group received systematic rehabilitation training, including maintenance of joint range of motion, residual muscle strength training, standing training, balance training, and functional electrical stimulation. The observation group received an individualized paraplegic locomotion brace and functional training according to the various spinal cord injury levels and muscle strength based on comprehensive systematic rehabilitation training. After 3 months of rehabilitation training, the observation group achieved therapeutic locomotion in 8 cases, family-based locomotion in 7 cases, and community-based locomotion in 3 cases. However, locomotion was not achieved in any of the control group patients. These findings suggest that individualized paraplegic braces significantly improve activity of daily living and locomotion in patients with thoracolumbar spinal cord injury.     

Psychological approach to the rehabilitation of the spinal cord injured: the contribution of relaxation techniques.

We analyse the benefit of learning relaxation techniques as an essential coping strategy in the behavioural medicine field. This has proved useful as a part of the newly spinal cord injured rehabilitation treatment or concerning later problems if there is readmission. We report the changes we have made in the relaxation standard methods to be used in spinal cord injured patients as well as the timing in the rehabilitation process when these techniques were applied.     

Rehabilitation after spinal cord injuries complicated by previous lesions

Since Sir Ludwig Guttmann introduced the comprehensive modern clinical approach to the rehabilitation of spinal cord injured patients much experience has been accumulated. Modern spinal cord injuries centres have opened throughout the world, treating mainly acute spinal cord injuries in young patients. At Stoke Mandeville Hospital we have had the opportunity to treat several spinal patients who had suffered previous neurological or orthopaedic disorders. These complicated combinations affected the rehabilitation process and the presentations show clearly different aspects of the problem.     

脊髓损伤早期手术及康复训练的疗效分析

目的介绍脊髓损伤早期脊髓探查和脊髓软化切开手术的术式和术后步行训练方法并分析其疗效。方法对40例完全性脊髓损伤30 d内的患者行脊柱脊髓损伤早期联合手术方式:一次性完成椎体内固定、松解硬脊膜下粘连、脊髓内外彻底清创减压,从而减轻脊髓二次损伤,保护神经细胞和残存神经纤维;术后辅以个体化脊柱固定减负背心,开展伤后早期康复训练;术后进行6个月的定期脊髓功能评价。结果术中术后未发生手术部位大出血、感染、残损加重等并发症。术后6个月,美国脊柱损伤协会(ASIA)残损分级A级17例、B级5例、C级11例、D级7例。ASIA评分:平均运动提高16.7分、针刺觉提高10.32分、轻触觉提高11.52分。结论在脊髓损伤早期行脊髓探查和脊髓软化切开手术是安全有效的,可恢复部分患者的部分脊髓功能。     

Rehabilitation of incomplete spinal cord pathology: Factors affecting prognosis and outcome

To determine the factors affecting the outcome of patients with incomplete spinal cord lesions, a retrospective study was performed of all such patients (n = 49) admitted to the neurorehabilitation unit of the National Hospital for Neurology and Neurosurgery, London, over a 2-year period. Disability on admission and discharge as measured by the Functional Independence Measure (FIM), change in disability, presence or absence of neurological recovery, patient age, level of the lesion and length of inpatient stay were the main outcome measures. Data were complete on 39 patients. There were 20 patients with cervical myelopathy, 15 with intrinsic cord abnormalities including syrinxes, 7 with spinal cord infarcts and 7 with other conditions such as tropical spastic paraparesis and hereditary paraparesis. Age ranged from 17 to 88 years (mean 53). Mean duration of stay was 40 days and the duration was related to the diagnosis. Nineteen of the patients made some neurological improvement, while all but one improved on the FIM. This functional gain did not correlate with the patients' age, initial disability or level of the lesion, but was related to the length of stay in the unit, and neurological improvement. We conclude that the needs of patients with progressive incomplete spinal cord lesions due to neurological disease differ from those of patients with acute traumatic spinal cord lesions and are best managed in a neurological rehabilitation unit. Efficacy appears to be related to neurological recovery and the duration of rehabilitation. This study underlines the value of combined neurological and rehabilitation. expertise in the management of this patient group and the need to incorporate both disciplines in planning service provision.     

A model for the future care of acute spinal cord injuries.

This is a review of the total care of those acute spinal cord injury patients in Ontario during the years 1969 and 1970, from extrication and transportation following the accident to death, or the completion of primary definitive rehabilitation. Information was extracted from the available ambulance records, the patients and many of the responsible physicians were interviewed personally. The study was detailed and intensive and included a review of each patient's hospital records in each hospital up to discharge from the rehabilitation programme into the community, or to a chronic care unit. The data was compiled in accordance with a detailed and lengthy questionnaire developed for this study. The incidence of acute cord injuries in Ontario in 1969 and 1970 amounted to 244; in 1969, 15.9 per million population and in 1970, 13.6 per million. As in other studies road accidents took first place, followed by falls from a height; sports injuries ranked third and 65.7% of these were caused by diving into shallow water. Age incidence, and incidence by month, day of week and time of day were identified. Fridays and Saturday afternoons in July and August are particularly hazardous. The study continued to the end of 1974 by which time 34 deaths had been recorded. Peak incidence of death occurred within fourteen days of injury. The most common cause of death was respiratory in origin. Geographical distribution was identified and the type of hospital treating the acutely injured patient. Fourteen percent of persons with spinal column injury suffered progressive or sequential spinal cord damage both prior to and following medical contact. The incidence of pressure sores and genitourinary sepsis and calculosis was high in all types of hospitals. The effect of operative treatment was noted in cases of complete quadriplegia and paraplegia. Of the 133 survivors who undertook a rehabilitation program, 84% returned to their homes and 59% achieved gainful employemnt or ongoing education. The cost was determined of general hospital services and rehabilitation programmes. A new model for the care of the spinal cord injury patients in Ontario was proposed.     

脊髓毛细胞型星形细胞瘤5例临床分析

目的 探讨脊髓毛细胞型星形细胞瘤(PA)的临床、影像学、病理学特点及治疗与预后.方法 回顾性分析5例脊髓PA患者的临床资料.5例患者均行手术全切除肿瘤,术后随访观察6～36个月.结果 本组5例患者均为成年人;术前MRI检查示肿瘤位于脊髓颈段2例、胸段1例、腰段1例、颈至腰段1例;首发症状为肢体疼痛4例、肢体麻木2例、肢...     

Comparative study of electrophrenic nerve stimulation and mechanical ventilatory support in traumatic spinal cord injury

Over the past two decades, the number of surviving apneic spinal cord injured patients has been increasing. Mechanical ventilation for home maintenance has been supplemented by electrophrenic respiration (EPR) since 1970. Nineteen patients who were totally mechanical ventilator dependent at discharge from rehabilitation in a spinal cord centre are compared with 18 patients discharged on EPR. There were more young males in the EPR group while the overall average ages were approximately the same. The mortality rates were approximately equal although the mechanical ventilator dependent patients expired earlier than the EPR group. Survivors on mechanical ventilation lived longer on an average and the vast majority of both groups were discharged to their home. There needs to be the establishment of a ventilatory dependent registry for spinal cord injury.     

功能锻炼在胸腰椎骨折合并脊髓损伤患者护理工作中的应用

目的探讨功能锻炼在胸腰椎骨折合并脊髓损伤患者护理工作中的应用。方法回顾性分析我院2014-05—2015-05收治的90例胸腰椎骨折合并脊髓损伤患者的临床资料,按照就诊时间顺序分为常规护理组与功能锻炼组,每组45例,对比2组康复情况、并发症发生率、焦虑抑郁评分。结果常规护理的康复恢复率为62.22%,功能锻炼组为82.22%,功能锻炼组的康复恢复率明显高于常规护理组,差异具有统计学意义(χ2=4.79,P0.05)。常规护理组并发症发生率为22.22%,功能锻炼组为8.89%,功能锻炼组的并发症发生率明显低于常规护理组,差异具有统计学意义(χ2=4.62,P0.05)。锻炼组焦虑评分与抑郁评分相比均明显低于常规护理组,差异具有统计学意义(t=4.32,P0.05;t=4.52,P0.05)。结论于常规护理基础上加用功能锻炼护理可提高胸腰椎骨折合并脊髓损伤患者的康复效果,降低并发症发生率,降低焦虑抑郁评分,值得推广与应用。     

Falls resulting in spinal cord injury: patterns and outcomes in an older population

Falls are the major cause of spinal cord injuries in older people. The pattern of injury seen most frequently is that of a central cord syndrome due to cervical hyperextension. The medical records of 58 patients over 50 years of age who sustained a spinal cord injury in a fall were reviewed for circumstances of onset, length of stay and outcomes of rehabilitation. The study identified elderly single or widowed men, and those who use alcohol, as high risk groups.     

Rehabilitation following spinal cord injury:how animal models can help our understanding of exercise-induced neuroplasticity

Spinal cord injury is a devastating condition that is followed by long and often unsuccessful recovery after trauma. The state of the art approach to manage paralysis and concomitant impairments is rehabilitation, which is the only strategy that has proven to be effective and beneficial for the patients over the last decades. How rehabilitation influences the remodeling of spinal axonal connections in patients is important to understand, in order to better target these changes and define the optimal timing and onset of training. While clinically the answers to these questions remain difficult to obtain, rodent models of rehabilitation like bicycling, treadmill training, swimming, enriched environments or wheel running that mimic clinical rehabilitation can be helpful to reveal the axonal changes underlying motor recovery. This review will focus on the different animal models of spinal cord injury rehabilitation and the underlying changes in neuronal networks that are improved by exercise and rehabilitation.     

The spinal cord in lightning injury: a report of two cases

We present 2 patients in whom the predominant neurological complication following lightning strike was spinal cord injury. One patient, who was followed for 5 years, showed clinical, electrophysiologic and MRI evidence of cervical spinal cord injury. This patient had significant recovery, which in part, may be related to early and intense rehabilitation. The second patient presented with the symptoms and signs of spinal shock which then evolved into a myelopathy. Follow-up several months later showed almost complete resolution of symptoms. These patients demonstrate that the prognosis of spinal cord injury complicating a lightning strike may not be uniformly poor.     

Multimodal treatment for spinal cord injury: a sword of neuroregeneration upon neuromodulation

Spinal cord injury is linked to the interruption of neural pathways,which results in irreversible neural dysfunction.Neural repair and neuroregeneration are critical goals and issues for rehabilitation in spinal cord injury,which require neural stem cell repair and multimodal neuromodulation techniques involving personalized rehabilitation strategies.Besides the involvement of endogenous stem cells in neurogenesis and neural repair,exogenous neural stem cell transplantation is an emerging effective method for repairing and replacing damaged tissues in central nervous system diseases.However,to ensure that endogenous or exogenous neural stem cells truly participate in neural repair following spinal cord injury,appropriate interventional measures(e.g.,neuromodulation)should be adopted.Neuromodulation techniques,such as noninvasive magnetic stimulation and electrical stimulation,have been safely applied in many neuropsychiatric diseases.There is increasing evidence to suggest that neuromagnetic/electrical modulation promotes neuroregeneration and neural repair by affecting signaling in the nervous system;namely,by exciting,inhibiting,or regulating neuronal and neural network activities to improve motor function and motor learning following spinal cord injury.Several studies have indicated that fine motor skill rehabilitation training makes use of residual nerve fibers for collateral growth,encourages the formation of new synaptic connections to promote neural plasticity,and improves motor function recovery in patients with spinal cord injury.With the development of biomaterial technology and biomechanical engineering,several emerging treatments have been developed,such as robots,brain-computer interfaces,and nanomaterials.These treatments have the potential to help millions of patients suffering from motor dysfunction caused by spinal cord injury.However,large-scale clinical trials need to be conducted to validate their efficacy.This review evaluated the efficacy of neural stem cells and magnetic or electrical stimulation combined with rehabilitation training and intelligent therapies for spinal cord injury according to existing evidence,to build up a multimodal treatment strategy of spinal cord injury to enhance nerve repair and regeneration.     

Utility of delayed spinal cord injury rehabilitation: an Italian study

Abstract The objective was to examine the utility of delayed spinal cord injury rehabilitation. The design was a retrospective study in the spinal unit of a large rehabilitation hospital. The participants were 117 patients at their first rehabilitation admission with an event to admission time of 90 days or more. The main outcome measures were the Barthel Index, Rivermead Mobility Index, Walking Index for Spinal Cord Injury and motor scores at admission and discharge; relative changes were examined. Patients showed a significant increase in all the outcome measures and achieved independence or assisted independence; significant neurological improvement and improvement in walking were recorded too; most of the patients were discharged home. The present data demonstrate the utility of delayed rehabilitation and highlight the importance of having rehabilitation in a specialised setting.     

Acute Onset of Intracerebral Hemorrhage due to Autonomic Dysreflexia

Autonomic dysreflexia is a clinical emergency syndrome of uncontrolled sympathetic output that can occur in patients who have a history of spinal cord injury. Despite its frequency in spinal cord injury patients, central nervous system complications are very rare. We report a man with traumatic high level incomplete spinal cord injury who suffered hypertensive right thalamic hemorrhage secondary to an episode of autonomic dysreflexia. Prompt recognition and removal of the triggering factor, the suprapubic catheter obstruction which led to hypertensive attack, the patient had a favorable functional outcome after the resorption of the hematoma and effective rehabilitation programme.     

Spinal dural arteriovenous fistulas—An underdiagnosed disease

Background Spinal dural arteriovenous fistulas (SDAVF) are rare and present with non–specific symptoms. The diagnosis is difficult and it is therefore conceivable that patients may not be recognized. Methods We reviewed the intake forms of patients who had been admitted to the spinal cord injury ward of a rehabilitation center in the period 1980–2004 to identify possible patients with an undiagnosed SDAVF. Clinical and radiological data were evaluated in selected cases. Results In 20 of 1429 newly admitted patients to the rehabilitation center (in 614 of whom trauma was not the cause), we restudied the CT myelograms, MRI scans or spinal angiograms and in two of these we found an undiagnosed SDAVF, and one cerebral dural arteriovenous fistula. One of these three was diagnosed with SDAVF 8 years after the admission to the rehabilitation center; the other two patients had never been diagnosed with SDAVF. In 9 patients a diagnosis of SDAVF had already been established by the time they were admitted to the spinal cord unit. In 20 other patients the admission diagnosis was a vascular lesion or 'progressive myelopathy' but appropriate radiological studies had been destroyed or had never been performed. Conclusion Our results suggest that spinal dural arteriovenous fistulas are an underdiagnosed condition.     

Psychiatric co-morbidities and patients with head and spinal cord trauma. Effects on acute hospital care

Three hundred twenty-one patients with traumatic head and spinal cord injuries were studied. Forty-two of these patients (13.1%) received psychiatric consultation services. Two types of consultation patients were identified--one receiving psychiatric consultation services in the acute-care hospital and one receiving psychiatric services in the post-acute care, long-term rehabilitation center. In order to assess the impact of psychiatric co-morbidities on hospital length of stay and charges, 40 consultation patients (23 acute and 17 rehabilitation) were matched to 87 control patients who received no psychiatric services. Matching was done on severity of injury, age, and sex. Psychiatric consultation cases had significantly longer stays than did matched controls. There were no differences on total charges.