Long-term body-weight-supported treadmill training for incomplete cervical spinal cord injury: a case report

[Purpose] To investigate the effects of long-term body-weight-supported treadmill training on walking ability and physical function in an elderly individual with incomplete cervical spinal cord injury. [Participant and Methods] The patient was a 68 year-old male with an incomplete spinal cord injury at the C3/C4 level, incurred when he was 56 years old. He initiated home-based body-weight-supported treadmill training using a body-weight-supported treadmill installed at his home. His walking ability was measured as the percentage of body weight load reduction, and his physical function was evaluated using manual muscle testing and measuement of the range of motion of his lower limbs. [Results] The physical function of the lower limbs was improved, maintained, or showed delayed decline until 9.5 years post-injury. [Conclusion] Long-term body-weight-supported treadmill training may improve, maintain, or at least delay the decline of the physical function of participants for several years, without causing any remarkable complications.     

康复训练对脊髓损伤大鼠外源性移植的骨髓源性神经干细胞的影响

目的:研究康复训练对移植到脊髓损伤大鼠体内的骨髓源性神经干细胞的存活、迁移、分化以及大鼠功能恢复的影响.方法:制作40只T10脊髓损伤动物模型,随机分成4组,分别为移植组(Y组)、康复训练组(K组)和康复训练联合细胞移植组(L组)、对照组(C组),在脊髓损伤后第7天将培养并标记好的骨髓源性神经干细胞移植到Y、L组中.分别在脊髓损伤后1、3、7 d及2、3、4、5、6周对所有动物进行BBB评分.免疫荧光染色观察移植的细胞在脊髓内的迁移、分化的情况.结果:BBB评分显示.细胞移植2周后,L组评分明显高于其他各组(P<0.01).免疫荧光染色显示,L组动物的神经干细胞存活率较Y组好.分化为神经元的比例更高.结论:康复训练能够促进移植的神经干细胞在脊髓中的存活并能促进其分化.有益于脊髓损伤大鼠后肢功能的恢复.     

运动训练对大鼠损伤远端脊髓及骨骼肌血管内皮生长因子表达的影响

目的:明确运动训练对大鼠损伤远端脊髓及骨骼肌血管内皮生长因子(VEGF)表达的影响,探讨运动促脊髓损伤功能恢复的机制。方法:成年雌性SD大鼠24只,采用改良Allen撞击法制作T9不完全性脊髓损伤模型。术后随机分为损伤后1d组、1周组、训练组(术后1周开始训练,共4周)、对照组(未行训练)。分别在损伤前、损伤后第1、2、3、4及5周时采用Basso-Beattie-Bresnahan(BBB)评分评定运动功能。取损伤后1d、1周,对照组及训练组大鼠L5—S1节段脊髓及腓肠肌新鲜组织,采用RT-PCR及Westernblot法测定VEGFmRNA及蛋白表达。结果:①对照组与训练组BBB评分均较损伤后1周、2周明显提高,但训练组较对照组增加更为显著(P<0.05);②训练组脊髓及腓肠肌VEGFmRNA及蛋白表达较对照组、损伤后1d、1周组显著增加(P<0.05);对照组与损伤1周组、1d组比较脊髓及腓肠肌内VEGF表达差异无显著性(P>0.05);但1周组脊髓内VEGF较1d组表达增加(P<0.05),而腓肠肌内VEGF表达较1d组降低(P<0.05)。结论:运动训练能有效诱导脊髓损伤大鼠远端脊髓及骨骼肌VEGF表达,促进运动功能恢复。     

脊髓损伤患者康复期生存质量的研究

目的：测量脊髓损伤患者住院康复期的生存质量,以及康复治疗对脊髓损伤患者生存质量的影响,探讨改善脊髓损伤患者生存质量的干预方式。方法：91例符合入选标准的住院康复期的脊髓损伤患者,分为综合康复组和传统康复组;100例符合入选标准的骨关节疾患非脊髓损伤需要康复治疗的患者作为对照组。结果：脊髓损伤患者26—50岁占57.14%,损伤原因交通事故、高处坠落、重物砸伤占73.63%。比较生存质量总分及各领域得分,脊髓损伤患者明显低于骨关节疾患非脊髓损伤患者(P<0.05)。治疗前后比较,综合康复组和传统康复组生存质量总分、生理领域得分、环境领域得分均有所提高(P<0.05),但心理领域得分有所下降,社会领域得分差异无显著性意义。治疗前后生存质量总分、生理领域得分综合康复组比传统康复组提高更明显(P<0.05)。治疗后两组BI均有明显提高（P<0.01）,综合康复组比传统康复组改善更明显（P<0.05）。结论：脊髓损伤患者以青壮年为主,康复期脊髓损伤患者的生存质量比骨关节疾患非脊髓损伤人群低。现代康复治疗技术与传统中医相结合的综合康复治疗能更有效地提高康复期脊髓损伤患者的日常生活活动能力及生存质量。     

Strategies for autonomy used by people with cervical spinal cord injury: a qualitative study

Purpose. To identify strategies used by people with high cervical spinal cord injury (SCI) to function autonomously. A multidimensional concept of autonomy was used, with four dimensions: independence, self-determination, participation and identification.

Methods. Qualitative methods were used, involving literature study and semi-structured interviews with eight individuals with high SCI who had been discharged from the rehabilitation centre for several years and were members of a sports club.

Results. Strategies for independence included making independent functioning a personal challenge and learning from others with SCI. Strategies for self-determination included keeping oneself informed, setting personal goals and being assertive. Strategies for participation were making challenges out of barriers, planning and organizing, asking and accepting help, and dealing with reactions from others. Strategies for identification involved taking life as it comes and focussing on positive aspects of life.

Conclusions. Different strategies are necessary for different dimensions of autonomy. Some strategies seem contradictory in terms of their effects on different dimensions of autonomy. Patients can be made aware of strategies for autonomy during the rehabilitation phase.     

电针结合耳针治疗急性脊髓损伤的临床研究

目的评估电针结合耳针治疗急性脊髓损伤的疗效和安全性。方法我院1999年1月～2004年5月期间急性脊髓损伤美国脊髓损伤学会（ASIA）损伤分级A级和B级患者56例，随机分为针灸治疗组和对照组。针灸治疗组采用双侧后溪和申脉点电针，与脊髓相关耳穴的耳针，同时配合康复治疗。对照组仅仅采用康复治疗。分别记录入院时、出院时及出院后1年ASIA损伤分级及ASIA神经（运动、感觉）功能状况评分、独立性功能评定（FIM）及不良反应。结果在神经（感觉和运动）功能和FIM评分方面针灸治疗组优于对照组（P〈0．05），无明显不良反应。结论早期采用电针结合耳针治疗急性脊髓损伤有较好的疗效和安全性。     

早期运动训练对脊髓损伤大鼠痛觉阈值及脊髓后角胶质细胞活化的影响

目的:观察早期运动训练对T10不完全性SCI大鼠机械性及热刺激痛觉阈值、脊髓后角小胶质细胞和星形胶质细胞活化的影响。方法:将24只成年雌性SD大鼠随机分为:假手术组(Sham组)、SCI-对照组(SCI-Sed组)和SCI-运动组(SCI-TT组)。SCI-Sed组和SCI-TT组使用改良Allen’s法制作T10不完全SCI模型,Sham组只暴露脊髓。SCI-TT组于SCI第8天行减重平板训练。于SCI术前、术后第1、7、14、21、28、35天使用Von Frey单丝及热刺激痛觉测试仪对大鼠的痛觉阈值进行评估。SCI 5周后,使用免疫组化技术对所有大鼠L4—5脊髓进行染色,观察脊髓后角小胶质细胞及星形胶质细胞活化情况,并对大鼠痛觉阈值与胶质细胞活化之间的相关性进行分析。结果:机械性痛觉阈值评估结果显示,SCI术后第1天,SCI-Sed组和SCI-TT组阈值均较Sham组增加(P0.05);之后两组阈值均低于Sham组(P0.05);第21—35天,SCI-TT组阈值明显高于SCI-Sed组(P0.05)。热刺激痛觉阈值结果显示,SCI术后第1天,SCI-Sed组和SCI-TT组痛觉阈值较Sham组均增加(P0.05);SCI 7天后,两组大鼠痛觉阈值均低于Sham组(P0.05);术后14—35天,SCI-TT组痛觉阈值明显高于SCI-Sed组(P0.05)。小角质细胞及星形胶质细胞免疫组化结果显示,SCI-Sed组和SCI-TT组脊髓后角内的阳性细胞数量多于Sham组(P0.05);而SCI-TT组明显少于SCI-Sed组(P0.05)。相关性分析显示,SCI后第35天,痛觉阈值与脊髓后角胶质细胞活化数量之间呈负相关(P0.001)。结论:早期运动训练对缓解SCI大鼠NP的发生有一定作用,其机制可能与抑制脊髓后角胶质活化相关。     

The effects of backward walking training on balance and mobility in an individual with chronic incomplete spinal cord injury: A case report

Background/Purpose: Individuals with incomplete spinal cord injuries (ISCIs) commonly face persistent gait impairments. Backward walking training may be a useful rehabilitation approach, providing novel gait and balance challenges. However, little is known about the effects of this approach for individuals with ISCIs. The purpose of this case report was to describe the effects of backward walking training on strength, balance, and upright mobility in an individual with chronic ISCI. Methods: A 28-year-old female, 11-years post ISCI (C4, AIS D) completed 18-sessions of backward walking training on a treadmill with partial body-weight support and overground. Training emphasized stepping practice, speed, and kinematics. Outcome measures included: Lower Extremity Motor Score, Berg Balance Scale (BBS), Sensory Organization Test (SOT), 10-Meter Walk Test (10MWT), 3-meter backward walking test, Timed Up and Go (TUG), and Activities-Specific Balance Confidence (ABC) Scale. Results: Strength did not change. Improved balance was evident based on BBS (20 to 37/56) and SOT scores (27 to 40/100). Upright mobility improved based on TUG times (57 to 32.7 s), increased 10MWT speed (0.23 to 0.31 m/s), and backward gait speed (0.07 to 0.12 m/s). Additionally, self-reported balance confidence (ABC Scale) increased from 36.9% to 49.6%. Conclusions: The results suggest that backward walking may be a beneficial rehabilitation approach; examination of the clinical efficacy is warranted.     

Strategies for autonomy used by people with cervical spinal cord injury: A qualitative study

Purpose. To identify strategies used by people with high cervical spinal cord injury (SCI) to function autonomously. A multidimensional concept of autonomy was used, with four dimensions: independence, self-determination, participation and identification.

Methods. Qualitative methods were used, involving literature study and semi-structured interviews with eight individuals with high SCI who had been discharged from the rehabilitation centre for several years and were members of a sports club.

Results. Strategies for independence included making independent functioning a personal challenge and learning from others with SCI. Strategies for self-determination included keeping oneself informed, setting personal goals and being assertive. Strategies for participation were making challenges out of barriers, planning and organizing, asking and accepting help, and dealing with reactions from others. Strategies for identification involved taking life as it comes and focussing on positive aspects of life.

Conclusions. Different strategies are necessary for different dimensions of autonomy. Some strategies seem contradictory in terms of their effects on different dimensions of autonomy. Patients can be made aware of strategies for autonomy during the rehabilitation phase.     

脊髓损伤病人的康复护理

从心理护理、制定康复护理目标、饮食指导、体位护理、膀胱功能训练、并发症的预防和护理、肢体功能训练、康复教育等8个方面介绍了脊髓损伤病人的康复护理。     

Work-rate-guided exercise testing in patients with incomplete spinal cord injury using a robotics-assisted tilt-table

Purpose: Robotics-assisted tilt-table (RTT) technology allows neurological rehabilitation therapy to be started early thus alleviating some secondary complications of prolonged bed rest. This study assessed the feasibility of a novel work-rate-guided RTT approach for cardiopulmonary training and assessment in patients with incomplete spinal cord injury (iSCI). Methods: Three representative subjects with iSCI at three distinct stages of primary rehabilitation completed an incremental exercise test (IET) and a constant load test (CLT) on a RTT augmented with integrated leg-force and position measurement and visual work rate feedback. Feasibility assessment focused on: (i) implementation, (ii) limited efficacy testing, (iii) acceptability. Results: (i) All subjects were able follow the work rate target profile by adapting their volitional leg effort. (ii) During the IETs, peak oxygen uptake above rest was 304, 467 and 1378?ml/min and peak heart rate (HR) was 46, 32 and 65 beats/min above rest (subjects A, B and C, respectively). During the CLTs, steady-state oxygen uptake increased by 42%, 38% and 162% and HR by 12%, 20% and 29%. (iii) All exercise tests were tolerated well. Conclusion: The novel work-rate guided RTT intervention is deemed feasible for cardiopulmonary training and assessment in patients with iSCI: substantial cardiopulmonary responses were observed and the approach was found to be tolerable and implementable.

• Implications for Rehabilitation

• Work-rate guided robotics-assisted tilt-table technology is deemed feasible for cardiopulmonary assessment and training in patients with incomplete spinal cord injury.

• Robotics-assisted tilt-tables might be a good way to start with an active rehabilitation as early as possible after a spinal cord injury.

• During training with robotics-assisted devices the active participation of the patients is crucial to strain the cardiopulmonary system and hence gain from the training.

     

脊髓损伤病人的康复护理

从心理护理、制定康复护理目标、饮食指导、体位护理、膀胱功能训练、并发症的预防和护理、肢体功能训练、康复教育等8个方面介绍了脊髓损伤病人的康复护理。     

阻断脑源性神经营养因子-酪氨酸激酶受体B通路后运动训练对脊髓损伤大鼠功能恢复的影响研究

目的:探讨阻断脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)-酪氨酸激酶受体B(tropomyosin-related kinase B,TrkB)信号通路后运动训练对脊髓损伤(spinal cord injury,SCI)大鼠运动功能恢复和突触可塑性的影响。方法:32只雌性SD大鼠被随机分为4组:损伤+PBS组(Sed-PBS组)、运动+PBS组(TT-PBS组)、损伤+TrkB/Fc组(Sed-TrkB/Fc组)及运动+TrkB/Fc组(TT-TrkB/Fc组)。于SCI术前1周进行L3-4鞘内置管。置管1周后使用改良Allen法制作T10不完全性SCI模型。于SCI术后第7天植入渗透压泵,并在Sed-PBS组和TT-PBS组的渗透压泵中灌入0.01M PBS,Sed-TrkB/Fc组和TT-TrkB/Fc组的渗透压泵中灌入TrkB阻滞剂(TrkB/Fc)。SCI后第8天,对TTPBS组和TT-TrkB/Fc组进行减重平板训练。术后第1天、3天、7天、14天、21天、28天和35天进行BBB评分。实验结束后取材,使用Western Blot和免疫组化染色技术分析检测突触后膜密度蛋白-95(postsynaptic density protein-95,PSD-95)及突触素(synaptophysin,SYP)表达情况。结果:术后14天,TT-PBS组BBB评分明显高于其他3组(P0.05);术后21—35天,TT-PBS组BBB评分显著高于其他3组(P0.001);术后28—35天,TT-TrkB/Fc组BBB评分高于Sed-PBS组及Sed-TrkB/Fc组(P0.05)。蛋白免疫印迹结果显示,TT-PBS组PSD-95及SYP相对蛋白表达量显著高于其他3组(P0.001);TT-TrkB/Fc组PSD-95及SYP相对蛋白表达量多于Sed-PBS组和Sed-TrkB/Fc组(P0.05)。免疫组化结果显示,与Sed-PBS组、Sed-TrkB/Fc组和TT-TrkB/Fc组相比,TT-PBS组的PSD-95相对蛋白密度明显增高(P0.01、P0.001、P0.01),且SYP相对蛋白密度也明显增高(P0.001);TT-TrkB/Fc组的PSD-95及SYP相对蛋白密度也高于Sed-TrkB/Fc组及Sed-PBS组(P0.05)。结论:阻断BDNF-TrkB信号通路可明显抑制运动训练对不完全性SCI大鼠运动功能恢复和腰髓突触标记蛋白表达的促进作用。     

运动训练对大鼠损伤远端脊髓超微结构及脑源性神经营养因子表达的影响

目的:明确运动训练对大鼠脊髓损伤(SCI)后远端脊髓超微结构及脑源性神经营养因子(BDNF)表达的影响。方法:成年雌性SD大鼠18只,采用改良Allen撞击法制作T9不完全性SCI模型。术后随机分为损伤后1周组、对照组(未行训练)及训练组(术后1周开始训练,共4周)。分别在损伤前、损伤后第1、2、3、4及5周时采用BBB评分评定运动功能,训练结束后取腰膨大段脊髓进行电镜观察超微结构,免疫组化检测BDNF蛋白表达情况。结果:①BBB评分:对照组与训练组BBB评分均较损伤后1周、2周明显提高,但训练组较对照组增加更为显著(P<0.05)。②超微结构:损伤后1周组,髓鞘排列规律整齐、轴索较均匀一致、核仁清晰;对照组髓鞘松散、轴索与髓鞘间出现空隙、轴突变性及空泡;训练组髓鞘完整、较薄、轴索均匀、髓鞘下及神经纤维周围基质中少见空泡。③BDNF免疫组化:BDNF免疫反应阳性产物多分布于脊髓前角,中央管周围也有出现,背角少见;训练组BDNF阳性染色颗粒增多,平均光密度值较损伤后1周组及对照组均显著增加(P<0.05)。结论:运动训练能减轻损伤远端脊髓继发性损害,并促进BDNF蛋白的表达。     

康复健康教育对脊髓损伤患者康复治疗依从性的研究

目的探讨康复健康教育对脊髓损伤(SCI)患者康复治疗依从性的临床意义。方法 2012年1月至2013年12月该院收治的SCI患者62例,随机分为观察组与对照组,各31例。对照组予以常规治疗与康复护理,观察组在对照组的基础上实施个性化康复健康教育,比较2组患者康复治疗的依从性。结果观察组患者对SCI疾病的认知水平和康复治疗的依从性评分显著高于对照组,差异有统计学意义(P0.05),观察组患者并发症发生率显著低于对照组,差异有统计学意义(P0.05)。结论对SCI患者实施康复健康教育,有利于提高患者康复治疗的依从性,降低其并发症发生率。     

Neuroprotective effects of ketorolac tromethamine after spinal cord injury in rats: an ultrastructural study

Introduction The aim of this study was to investigate the effects of intrathecally administered ketorolac tromethamine on ultrastructural changes of the spinal cord in spinal cord-traumatised rats. Methods Male Wistar rats were used and divided into three groups for this study. The rats in Group S (n=6) were control animals and received 10 μl of saline. Groups K50 (n=6) and K400 (n=6) received intrathecally 50 μg and 400 μg of ketorolac tromethamine, respectively, immediately after trauma was induced. All rats underwent laminectomy and the spinal cord was traumatised using the clip-compression technique. Electron microscopic examination of the cord samples was carried out 3 days after spinal cord injury. Results Ultrastructural findings showed severe injury with extensive axoplasmic and cytoplasmic oedema in Group S. Minor neural damage occurred in Group K50 and increased ultrastructural protection was observed in the Group K400. Conclusion This study demonstrates that intrathecal administration of ketorolac tromethamine protects the spinal cord following injury in rats.     

康复护理对脊柱骨折伴脊髓损伤患者日常生活能力及住院时间的影响

目的 分析康复护理对脊柱骨折伴脊髓损伤患者日常生活能力及住院时间的影响.方法 将我院2018年1月至2019年12月收治的80例脊柱骨折伴脊髓损伤患者按照护理方案的不同分为对照组(n=40)与试验组(n=40).对照组给予常规护理干预,试验组在常规护理干预的基础上行康复护理.比较两组干预前、后的日常活动能力、运动功能改...     

Exploring factors facilitating adults with spinal cord injury rejoining the workforce: a pilot study

Abstract

Background: Return-to-work (RTW) rates after spinal cord injury (SCI) in the USA are very low and are continuing to decline. Previous research has attempted to identify factors facilitating RTW; however, the phenomenon of RTW involves many personal factors and predicting RTW success remains difficult. Purpose: The purpose of this pilot study was to explore the factors facilitating adults with SCI rejoining the workforce in an urban area in order to identify items that may be emphasized in the rehabilitation process. Methods: The study was completed using qualitative methods. Four adults who had acquired a traumatic SCI in adulthood and were currently employed participated. Their experiences in RTW after injury were collected via semi-structured interviews and photography of assistive devices. Results: The most common facilitating factor was motivation, with family and rehabilitation professionals serving as extrinsic motivators. Other facilitators were resources and perceived benefits. Conclusions: Motivation and resources were important facilitators, including rehabilitation professional’s personal influence and therapies, and resource assistance from state agencies. The results indicate that practitioners can play an important role in influencing RTW, and resources from state agencies are helpful when individuals know how to access and utilize them.

• Implications for Rehabilitation

• Assistive technology supports successful return to work after SCI.

• Motivation strongly influences return to work after SCI and can be influenced by rehabilitation professionals, family and community members.

• Patients should be well informed about how to access assistance programs such as vocational rehabilitation.

     

电针辅助治疗对急性不完全性脊髓损伤的疗效

目的探索针刺配合神经外科治疗急性不完全性脊髓损伤的方法和疗效。方法对照组9例，根据手术指征确定术式，并予药物治疗；治疗组7例，除上述神经外科治疗外，采用电针刺激夹脊穴及辨证取穴。比较两组疗效。结果对照组显效2例，好转4例，无效3例；治疗组治愈6例，好转1例。结论配合针刺治疗能提高急性脊髓损伤手术后疗效。     

持续性脊髓压迫对脊髓损伤程度的影响

目的 探讨脊髓损伤(SCI)后脊髓压迫时间对损伤程度的影响。方法 以大脑皮层诱发电位(CSEP)和不同压迫时间为参数,自行设计一种犬的运动—静止压迫型SCI模型,选择T13为损伤中心,压迫脊髓,当 CSEP波幅下降达基础值的 50%时,维持静止压迫。将28只犬随机分为A、B、C、D 4组,A、B、C组脊髓分别受压30 min、90 min和180 min,D组为对照组,观察各组动物的组织病理学、影像学和行为学变化。结果 损伤组脊髓组织学均有损害,MRI显示损害程度随脊髓受压时间的延长逐渐加重( P<0.01);至术后28 d,各损伤组动物后肢功能均有恢复,BBB分级评分法评估组间有显著性差异( P <0.05)。结论 SCI后持续性脊髓压迫能加重损伤程度,应尽早解除脊髓压迫。