A comparison of one year outcomes between standardized locomotor training and usual care after motor incomplete spinal cord injury: Community participation,quality of life and re-hospitalization

Context/Objective:Spinal cord injury (SCI) often results in a significant loss of mobility and independence coinciding with reports of decreased quality of life (QOL), community participation, and medical complications often requiring re-hospitalization. Locomotor training (LT), the repetition of stepping-like patterning has shown beneficial effects for improving walking ability after motor incomplete SCI, but the potential impact of LT on psychosocial outcomes has not been well-established. The purpose of this study was to evaluate one year QOL, community participation and re-hospitalization outcomes between individuals who participated in a standardized LT program and those who received usual care (UC).Design/Setting/Participants:A retrospective (nested case/control) analysis was completed using SCI Model Systems (SCIMS) data comparing one year post-injury outcomes between individuals with traumatic motor incomplete SCI who participated in standardized LT to those who received UC.Outcome Measures:Outcomes compared include the following: Satisfaction with Life Scale (SWLS™), Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF™), and whether or not an individual was re-hospitalized during the first year of injury.Results:Statistically significant improvements for the LT group were found in the following outcomes: SWLS (P = 0.019); and CHART subscales [mobility (P = <0.001)]; occupation (P = 0.028); with small to medium effects sizes.Conclusion:Individuals who completed a standardized LT intervention reported greater improvements in satisfaction with life, community participation, and fewer re-hospitalizations at one year post-injury in comparison to those who received UC. Future randomized controlled trials are needed to verify these findings.     

Verhandlungen Ärztlicher Gesellschaften

Ohne Zusammenfassung     

Verhandlungen Ärztlicher Gesellschaften

Ohne Zusammenfassung     

Verhandlungen Ärztlicher Gesellschaften

Ohne Zusammenfassung     

Verhandlungen Ärztlicher Gesellschaften

Ohne Zusammenfassung     

The state of leucocyte adhesiveness/aggregation in the peripheral blood: A new and independent marker of mental stress

A direct slide test was used to detect the presence of aggregated white blood cells in the peripheral blood. By this means the state of leucocyte adhesiveness/aggregation (LAA) during acute mental stress was determined in 22 healthy volunteers and compared to the white blood cell count (WBCC). The LAA test proved to be more sensitive (73 per cent) as compared to the WBCC (40 per cent). This increased sensitivity is a result of a greater deviation of the LAA from normal values (obtained in 22 healthy controls) than the one obtained in the absolute cell number in the circulating pool. It is assumed that factors released during stress induce a state of increased LAA. Hence the determination of the adhesive state together with the absolute WBCC may yield a rapid, cheap and efficient laboratory criterion for the detection of mental stress.     

Cochlear implants in deaf children

The results to date with the 3M/House cochlear implant in children have been extremely encouraging. Statistically and clinically significant changes show that the implant can provide improvements in auditory detection and discrimination as well as in speech production. As with any intervention, results range from outstanding for some children (open-set speech discrimination and/or intelligible speech) to minimal for others (no stimulation or little improvement in speech). Until long-term studies can be completed, the implant will undoubtedly remain controversial. However, professionals involved in the care of a child who is hearing-impaired should be informed that the field of cochlear implantation is rapidly expanding. A number of different cochlear implants are currently undergoing clinical trials in adults. Besides the 3M/House device, the FDA has recently approved a second device, the Nucleus Multichannel Cochlear Implant, for investigation in children. The treatment of profound deafness is changing in children with the cochlear implant as an option for those not benefiting significantly from hearing aids. However, some important aspects of a deaf child's management have not changed and will not change: the need for early diagnosis and multidisciplinary management. The first five years of life are the language acquisition years. Proper management during these years is critical if the hearing-impaired child's handicap is not to dominate his or her future and limit potential for a successful, happy life.     

Catecholamine-associated changes in the state of leukocyte adhesiveness/aggregation in the peripheral blood

This article further explores the effects of stress on leukocyte adhesiveness. The concentration of plasma catecholamines as well as the LAA values were examined in 16 volunteers during a cold pressor test and in 15 volunteers following physical activity. A significant correlation between LAA values and plasma norepinephrine, dopamine and epinephrine was noted. In addition, experimental studies of anaesthetized dogs infused with dopamine and norepinephrine showed increased LAA values, and an insulin-induced hypoglycaemic animal model for adrenergic stress indicated an inverse correlation between serum glucose concentrations and LAA values. Finally, in the presence of an MAO inhibitor, norepinephrine significantly increased the state of LAA in vitro. Thus, there exists an association between adrenergic stress and the appearance of sticky leukocytes in the circulating pool. We assume that, at least in part, this stickiness results from a direct effect of the catecholamines on the adhesive properties of the cells. Other factors might be related to the decreased endothelial adhesiveness towards the white blood cells as well as the concomitant effect of other mediators released during stress. This study also supports our notion that the state of LAA in the peripheral blood can serve as a useful stress marker.