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PubMed1999

Theoretical aspects of sensory substitution and of neurotransmission-related reorganization in spinal cord injury.

Spinal cord rehabilitation has progressed enormously since World War II, and persons with spinal cord injuries now have long life expectancies. Research has recently concentrated on improvement of the quality of life, and on neural mechanisms of recovery. This article will explore some aspects of both of these areas. In the first section, the potential applications of sensory substitution systems for such functions as sex sensation and sensation from feet and from robotic hands will be examined. In the second section, the potential role of nonsynaptic diffusion neurotransmission (NDN) in neural reorganization after spinal cord injury will be considered. This article includes portions of previous publications and reports.

Animals↗
PubMed1991

A functional classification of respiratory compromise in spinal cord injury.

Spinal cord injury (SCI) patients have unique care needs, particularly related to the respiratory system. Respiratory problems now comprise a major cause of death in the acute and chronic phases of SCI, especially among quadriplegics. Previous literature has analyzed respiratory muscle dysfunction in SCI according to neurologic levels of injury (Alvarez, Peterson & Lunsford, 1981; McMichan, Michel & Westbrook, 1980). In general, the higher the level of injury, the greater the respiratory compromise and need for ventilatory assistance. Although level of injury is significant, it cannot be used as the sole determinant of respiratory compromise. For example, a 25 year old C4 quadriplegic with an intact diaphragm might have less respiratory impairment than a 60 year old C6 quadriplegic with CHF and a history of COPD. A new classification of SCI patients according to amount of respiratory compromise was developed by our team at the Spinal Cord Injury Unit at the Palo Alto VA Medical Center. The patient is scored in three categories: 1) level of injury; 2) completeness of injury; and 3) associating factors, i.e. age, preinjury chronic lung disease. The purpose of this grouping is to better predict the amount of ventilatory impairment in SCI patients. Used during the initial assessment, patients at high risk for impairment could be determined and optimal respiratory care initiated. This classification can also be used as a clinical nursing tool. Using this scoring system, the nurse could anticipate the patient's respiratory needs, i.e. suctioning, chest physiotherapy, oxygen, hydration, nutritional support and teaching of patient and family in order to comprehensively plan and implement care.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

Clinical trials of pharmacotherapy for spinal cord injury.

Spinal cord injury remains with limited natural recovery and only a few general ineffective treatment options. Recent publications have reported enhanced neurologic recovery with the use of methylprednisolone and GM-1 ganglioside. The results of the Maryland GM-1 Ganglioside Study reported a significant drug effect with respect to the fraction of patients that had a change of two or more Frankel grades from entrance into the study to 1-year follow-up. This study formed the basis for the currently ongoing larger placebo-controlled multicentered study using Sygen GM-1 following acute spinal cord injury. This study has entered 797 patients and is expected to present results in early 1998.

Adult↗
PubMed2003

Upregulation of sodium channel Nav1.3 and functional involvement in neuronal hyperexcitability associated with central neuropathic pain after spinal cord injury.

Spinal cord injury (SCI) can result in hyperexcitability of dorsal horn neurons and central neuropathic pain. We hypothesized that these phenomena are consequences, in part, of dysregulated expression of voltage-gated sodium channels. Because the rapidly repriming TTX-sensitive sodium channel Nav1.3 has been implicated in peripheral neuropathic pain, we investigated its role in central neuropathic pain after SCI. In this study, adult male Sprague Dawley rats underwent T9 spinal contusion injury. Four weeks after injury when extracellular recordings demonstrated hyperexcitability of L3-L5 dorsal horn multireceptive nociceptive neurons, and when pain-related behaviors were evident, quantitative RT-PCR, in situ hybridization, and immunocytochemistry revealed an upregulation of Nav1.3 in dorsal horn nociceptive neurons. Intrathecal administration of antisense oligodeoxynucleotides (ODNs) targeting Nav1.3 resulted in decreased expression of Nav1.3 mRNA and protein, reduced hyperexcitability of multireceptive dorsal horn neurons, and attenuated mechanical allodynia and thermal hyperalgesia after SCI. Expression of Nav1.3 protein and hyperexcitability in dorsal horn neurons as well as pain-related behaviors returned after cessation of antisense delivery. Responses to normally noxious stimuli and motor function were unchanged in SCI animals administered Nav1.3 antisense, and administration of mismatch ODNs had no effect. These results demonstrate for the first time that Nav1.3 is upregulated in second-order dorsal horn sensory neurons after nervous system injury, showing that SCI can trigger changes in sodium channel expression, and suggest a functional link between Nav1.3 expression and neuronal hyperexcitability associated with central neuropathic pain.

Animals↗
PubMed1990

Psychological consequences of spinal injury: a review of the literature.

The traumatic nature of spinal cord injury necessitates adjustments for the individual physically, socially, vocationally and sexually, as well as placing great strain on the family. Although one would suspect a high prevalence of psychological disruption following spinal cord injury, there is still much debate concerning the extent of the psychological reaction to such a trauma. This situation can partly be attributed to the lack of systematic research characteristic of most studies in this area. This paper reviews more recent literature which has investigated psychological morbidity in persons with spinal cord injury. The inadequacies of this research are discussed and suggestions for future research and psychological treatment for the spinal injured are provided.

Adaptation, Psychological↗
PubMed2002

Spinal injury: optimising the imaging options.

There have been numerous documented attempts in formulating risk-based guidelines for the exclusion of spinal injury using conventional radiography. Although the advent of computed tomography (CT) (including spiral and multi-slice) and magnetic resonance imaging (MRI) confirmed the known limitations of conventional radiography, there is still a requirement to define optional use of these modalities in a trauma setting. This chapter addresses these issues by reviewing the literature and provides a synopsis of the current thinking in the appropriate sections (adult, paediatric, symptomatic, asymptomatic, etc.) in the quest of finding out the correct answers on how best to exclude/confirm spinal trauma.

Age Factors↗
PubMed1994

Prediction of ambulatory performance based on motor scores derived from standards of the American Spinal Injury Association.

Assessment of strength using motor scores derived from the standards of the American Spinal Injury Association (ASIA) was compared with assessment using motor scores based on biomechanical aspects of walking in the prediction of ambulatory performance. Measurements of strength, gait performance, and the energy expenditure were performed in 36 spinal cord injured patients. The ASIA scoring system compared favorably with the biomechanical scoring system. The ASIA score strongly correlated with the percent increase in the rate of O2 consumption above normal (p < .0005), O2 cost per meter (p < .0006), peak axial load exerted by the arms on crutches (p < .0001), velocity (p < .0001), and cadence (p < .0001). Patients with lower extremity ASIA scores < or = 20 were limited ambulators with slower average velocities at higher heart rates, greater energy expenditure, and greater peak axial load exerted on assistive devices than patients with lower extremity ASIA scores > or = 30 who were community ambulators. We conclude the ASIA motor score is a simple clinical measure that strongly correlates with walking ability.

Adult↗
PubMed1993

Spinal injury in sport: epidemiologic considerations.

Review of previous epidemiologic studies, involving both contact and noncontact sports at all levels of competition ranging from the high school level to the professional level, reveals that the overwhelming majority of sports injuries related to the spine are soft-tissue injuries and self-limiting. The spectrum of injury is related to the mechanism, the force involved, and the point of application of the force. The immediate consequence of a soft-tissue injury is decreased immobilization with result in deconditioning. Most athletes have a strong desire to compete both at the amateur and professional levels. The inability to compete can have both psychologic and emotional consequences. The professional athlete is potentially burdened with financial consequences as well. The mainstay of prevention and treatment is maintaining good strength and flexibility through conditioning. Injuries can occur at the level of the disc, resulting in disc herniation, disc degeneration, and ultimately developmental stenosis. The biochemistry and biomechanics of the disc are age related, and thus, the adolescent and older athlete may have different concerns with regards to the diagnosis, treatment, and prognosis after injury to the spine. Remember, not only injuries cause back pain in the athlete. Athletes, too, can have tumors, infection, rheumatologic disorders, and other nontraumatic etiologies of back pain. Rarely athletic injuries to the spine do result in significant neurologic compromise. These injuries have been brought to national attention with the tragic recent injuries of well-known professional football and hockey athletes.(ABSTRACT TRUNCATED AT 250 WORDS)

Athletic Injuries↗
PubMed1992

The evolution of compensated occupational spinal injuries. A three-year follow-up study.

This study was undertaken to follow up an incidence rate study of spinal injuries carried out from a cross-sectional random sample consisting of 2,342 workers who were compensated at least once in the year 1981 by the Quebec Worker's Compensation Board (QWCB) for an absence from work. These workers were followed for 3 years using the QWCB information system to record any recurrence of compensated absence from work. A total of 850 (36.3%) had at least one recurrence, and had longer episodes of absence than those without a recurrence (P less than 0.0001). Of these 850 workers, 824 (96.9%) had less than five recurrences and showed a systematic trend of gradual increasing duration of absence on each subsequent recurrence (P less than 0.05 in a repeated measures analysis of variance). A positive relationship was found between the duration of the initial episode of absence from work and the subsequent history of absence from work, both in terms of risk of recurrence (P less than 0.001) and of cumulated absence from work (P less than 0.0001), after controlling for age, sex, and site of symptoms. The computed instantaneous risk of entering a recurrence in a 31 year-old man experiencing lumbar symptoms, was 19.9% (95% confidence interval = 19.8-19.9) in the year following an initial episode of one day duration, and 26.7% (95% confidence interval = 24.3-29.3) after an initial episode of 6 months.

Absenteeism↗
PubMed1985

Opiate antagonist WIN44,441-3 stereospecifically improves neurologic recovery after ischemic spinal injury.

In the unanesthetized rabbit, temporary aortic occlusion results in predictable patterns of spinal cord injury. We use this "spinal stroke" model to assess the potential role of opiate antagonists in treating CNS ischemia. WIN44,441-3 (WIN(-], an opiate antagonist with enhanced activity at the kappa-receptor, reduced motor dysfunction after ischemic spinal cord injury. The effect was stereospecific and dose-related; beneficial actions were seen at doses as low as 40 micrograms/kg. Opiate receptor antagonists may be therapeutically useful in ischemic CNS injury, and the beneficial actions of these compounds may be at the kappa-receptor site.

Animals↗
PubMed2002

Spinal injuries resulting from horse riding accidents.

Injuries sustained as a result of horse riding are common. Serious injuries to the nervous system are the most dangerous. An analysis has been made of 11 papers, new figures produced by surveying Stoke Mandeville, Oswestry and Odstock spinal units and by searching the internet to determine their frequency and distribution. Head injuries outnumber spinal injuries by five to one. In contrast to other sporting accidents, there are more lumbar and thoracic than cervical injuries and more women are injured than men (though this may just be a reflection of the fact that there are more women riders than men). Of all horse riding activities, jumping is most likely to produce a spinal injury.

Accidental Falls↗
PubMed2000

AIDA reduces glutamate release and attenuates mechanical allodynia after spinal cord injury.

Spinal cord injury (SCI) leads to an increase in extracellular excitatory amino acid (EAA) concentrations, resulting in glutamate receptor-mediated excitotoxicity and central sensitization. To test contributions of group I metabotropic glutamate receptors (mGluRs) in SCI induced release of glutamate and in behavioral outcomes of central sensitization following injury, we administered 1-aminoindan-1,5-dicarboxylic acid (AIDA; 0.1 nmol intraspinally), a potent group I mGluR antagonist, to rats immediately after spinal cord contusion injury. EAAs were collected by microdialysis and quantified using HPLC. AIDA significantly decreased extracellular glutamate but not aspartate concentrations and significantly attenuated the development of mechanical but not thermal allodynia. These results suggest mGluRs play an important role in injury-induced EAA release and in central sensitization following SCI.

Animals↗
PubMed1982

The treatment of thoracolumbar spinal injuries with paresis by conservative versus surgical methods.

18 patients with cord or root involvement in thoracolumbar injuries underwent posterior spinal surgery, including 11 Harrington instrumentations. 11 similar patients were treated conservatively. Surgery offered no definite advantage for neural recovery, nor did it curtail the duration of hospitalisation. However, it significantly decreased post-traumatic kyphotic deformity and improved the vertebral alignment. Morbidity and implant failure were noted in 27% of the operated cases. It would appear that operative stabilisation of the thoracolumbar injuries of the spine is indicated in selected cases where there is a risk of significant post-traumatic kyphotic deformity with gross vertebral body displacement.

Adult↗
PubMed2001

Changes in exploratory behavior as a measure of chronic central pain following spinal cord injury.

Spinal cord injury (SCI) produces abnormal pain syndromes in patients that lead to changes in evoked and spontaneous behaviors. To test if a spontaneous component of pain-like behavior could be measured in a rodent model of chronic central pain (CCP), exploratory behavior (rearing events, rearing time, active time, rest time, distance traveled, and total activity) of adult male rats, subjected to sham surgery or spinal cord contusion injury treated with either vehicle (saline) or gabapentin (30 mg/kg, i.p.), was recorded. SCI was produced at spinal segment T10 using the NYU impactor device (10-g rod, 2.0-mm diameter, 12.5-mm drop height). Activity measures were collected on postsurgical days (PSD) 14, 28, and 60, and compared to presurgical activity. Sham control activity was not significantly different compared to presurgical activity in any measured parameter. SCI vehicle-treated rats demonstrated a significant decrease in total rearing time on PSD 14 and by PSD 28 significant differences in total activities where seen in all parameters measured. SCI gabapentin-treated rats did not display differences in total rearing time until PSD 28 and a significant difference in total activity of all measured parameters was not seen until PSD 60. No difference in hindlimb locomotor ability between SCI groups or sedation effects of gabapentin was found using open field BBB scores. We interpret the differences in exploratory behavior to reflect spontaneous behavioral changes due to CCP since (1) when locomotor ability was greatest, activity was lowest and (2) gabapentin attenuates the temporal decrease in activity. This study demonstrates that spontaneous as well as evoked behaviors may be used to evaluate CCP following SCI.

Acetates↗