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PubMed1991

Proximal femoral resection and myocutaneous flap for treatment of pressure ulcers in spinal injury patients.

A radical proximal femoral resection and flap procedure were used to treat infected trochanteric ulcers communicating with the hip joint in patients with spinal cord injuries. Postoperatively, femoral motion and pistoning were prevented by an abduction pillow and antispasmodic medication. The results of 25 patients and 26 hips with an average follow-up of 14.5 months are presented. Wound closure was achieved in 24 of 26 hips while patients were in the hospital. All wounds eventually healed, and all infections were eradicated. Seven patients had associated clinically significant heterotopic ossification. All of these patients had elimination of infection and postoperative restoration of wheelchair sitting. It is concluded that this radical procedure is extremely effective in treating deep, recalcitrant trochanteric ulcers around the hip. The procedure may potentially be used to treat heterotopic ossification about the hip and restore sitting capability in patients with spinal cord injuries.

Adult↗
PubMed2001

Chronic pain after spinal injury: interference with sleep and daily activities.

OBJECTIVES: To determine how chronic pain after spinal cord injury (SCI) interfered with sleep, exercise, work, household chores, and other daily activities and to define which clinical aspects of pain and psychosocial factors best predicted the extent of interference. DESIGN: Postal survey; follow-up to a previous survey conducted 6 months earlier. SETTING: General community. PARTICIPANTS: Individuals (n = 217) with traumatic SCI and chronic pain. INTERVENTION: Subjects answered questions regarding frequency of interference caused by pain on 5 activities: sleep, work, exercise, household chores, and other daily activities. Asked to self-report sadness, fatigue, or anxiety; and to describe location, quality, and intensity of pain. MAIN OUTCOME MEASURES: Demographic data (gender, age, level of injury); sociodemographic data (education, employment); self-reported psychosocial outlook; clinical characteristics of pain: location (drawing), quality (descriptors), and intensity (2 numeric rating scales). Regression analysis. RESULTS: The questionnaire was returned by 65.8% of the sample (217/330). A large number of the participants (77.3%) reported frequent interference caused by pain, ie, "often" to "always" in 1 or more of the 5 activities. The combination of high pain intensity and the use of multiple pain descriptors was significantly associated with frequent interference with falling asleep. Frequent sleep interruption was significantly associated with high pain intensity, male gender, anxiety, and higher age at time of injury. In working individuals, frequent interference due to pain was significantly associated with multiple pain descriptors, anxiety, low level of education, and being older at time of injury. CONCLUSION: Reported extent of pain interference in various areas of activity is related to clinical symptoms of pain as well as to psychologic and psychosocial factors rather than level of injury. The relationship between frequent interference, pain intensity, and multiple descriptors indicate that individuals experiencing several types of pain of high intensity are more likely than others to experience frequent interference with a variety of daily activities including sleep.

Activities of Daily Living↗
PubMed1979

Retrospective survey of neurotraumatic admissions to a teaching hospital: comparison of data on spinal injuries after 10 to 16 years.

A retrospective survey of 202 patients with spine and cord injuries who were treated in the Prince Henry Hospital and the Prince of Wales Hospital from January, 1960, to December, 1965, was published in 1968. Ten years later, 98 patients with spine and cord injuries who were admitted over a two-year period (January, 1975, to December, 1976) were similarly studied. The data of the two surveys were compared, and changes in clinical and epidemiological features were evaluated.

Adolescent↗
PubMed1988

Spinal cord injury or spinal anesthesia eliminates seizures in myelin-deficient rats.

The generalized tonic seizures that occur in myelin-deficient rats can be eliminated temporarily by spinal cord injury or spinal anesthesia. These observations imply that the seizures in this mutant can be triggered by activity in the spinal cord. The results are consistent with an earlier proposal that axons in myelin-deficient CNS fiber tracts can interact to produce abnormal excitation.

Anesthesia, Spinal↗
PubMed1991

Common spinal injuries in athletes.

Special needs of athletes with spine injuries must be considered when planning for treatment of these patients. The patients wish to return to competition safely but rapidly. Nurses must understand the patients'/athletes' need but put them into perspective with respect to the diagnosis, treatment, and degree of disability. Support, encouragement, and understanding from a knowledgeable health professional are invaluable.

Athletic Injuries↗
PubMed1993

Effects of TRH and high-dose corticosteroid therapy on evoked potentials, and tissue Na+,K+ and water content in experimental spinal injury.

The therapeutic effects of continuous infusion of thyrotropin-releasing hormone (TRH) and methylprednisolone (MP) in experimental spinal cord injury were studied in Swiss albino rats. Thirty rats received a 53-g clip-compression injury on the cord at T1, then were allocated randomly and blindly to one of three treatment groups (ten animals in each): (1) control; received equal volumes of saline solution; (2) MP; received 30 mg/kg methylprednisolone i.v. 1h after trauma, followed by infusion of 5.4 mg/kg/per hour i.v. for 3h; (3) TRH; received 2 mg/kg TRH i.v. 1h after trauma, followed by infusion of 1 mg/kg/per hour i.v. for 3h. MP and TRH treatments significantly improved somatosensory-evoked potentials (SEPs; P < 0.001). Both treatments significantly reduced water content, decreased Na+ content and increased the K+ content of the cord segment that included the centre of the impact (P < 0.01). Our data provide evidence for the beneficial effects of high-dose corticosteroid and TRH in promoting electrophysiological recovery and preserving spinal cord tissue following experimental injury.

Animals↗
PubMed1998

Asymmetric bipedal locomotion--an adaptive response to incomplete spinal injury in the chick.

The purpose of this study was to compare the asymmetric gait induced by unilateral spinal cord injury in chicks with asymmetric gaits of other bipeds and quadrupeds. After lateral hemisection of the left thoracic spinal cord, kinetic (ground reaction forces) and kinematic (distance and timing) data were recorded as chicks moved overground unrestrained. Ground reaction forces were analyzed to obtain the mechanical energy changes throughout the stride. Kinematic measurements were obtained over a range of speeds to determine the velocity-dependent characteristics of the gait. Hemisected chicks adopted an asymmetric hopping gait in which the animals hopped from the right leg (contralateral to the lesion) onto the left (ipsilateral) leg but then fell forward onto the right leg. Mechanical energy fluctuations throughout a single stride (i.e., two steps) approximated the oscillations that occur during a single walking step of control animals. When examined over a range of velocities, asymmetries in limb timing remained constant, but distance measurements such as step length became more symmetric as speed increased. The results show that, after spinal hemisection, adaptations of the remaining neural circuitry permitted the production of a locomotor pattern that, in addition to providing effective support and propulsion, incorporated some of the energy-conserving mechanisms of the normal walk. Adjustment of this novel locomotor pattern for different velocities further demonstrates the flexibility of locomotor circuitry. Comparisons with other studies shows that this gait shares some temporal and energetic features with asymmetric gaits of several bipedal species, including humans. In particular, hemisected chicks and some hemiplegic humans adopt an asymmetric gait in which maximum energy recovery occurs during the stance of the affected limb; these similarities probably relate to common mechanical constraints imposed on bipedal forms of terrestrial locomotion.

Animals↗
PubMed1991

Spinal injury rehabilitation: do staff and patients agree on what they are talking about?

The psychological effects of spinal cord injury on patients themselves have been discussed in a number of articles, but few studies have been made of patients and staff, perceptions of the effectiveness of the treatment they receive and supply. An earlier investigation by the present authors showed that there were differences between the views of staff and of patients in terms of their understanding of rehabilitation. As a consequence, a number of procedural changes were implemented in the Spinal Unit, in an attempt to improve the information provided for patients and their relatives, and the selection and support of staff. Reanalysis of the staff and patients views of rehabilitation were carried out 12 months later using a standardised questionnaire and any changes in response were noted. The present findings are analysed, and the potential implications for other units are noted.

Analysis of Variance↗
PubMed2006

Clinical trial of exercise for shoulder pain in chronic spinal injury.

BACKGROUND AND PURPOSE: The high prevalence of shoulder pain in wheelchair users may be related to the repetitive use of the upper limbs during self-care and wheelchair-related activities. The purpose of this study was to determine the effects of a controlled 8-week, scapula-focused exercise intervention on pain and functional disability in people with spinal cord injury (SCI) and shoulder impingement symptoms. SUBJECTS: Forty-one manual wheelchair users (with SCI and spina bifida), both with (n=21) and without (n=20) shoulder impingement symptoms, participated. METHODS: The study design was a clinical trial with an asymptomatic control group. Subjects completed the Wheelchair User's Shoulder Pain Index (WUSPI) and the Shoulder Rating Questionnaire (SRQ) and provided patient satisfaction scores at initial and 8-week visits. Subjects in the intervention group were instructed in a home exercise program consisting of stretching and strengthening exercises. Subjects in the asymptomatic control group received no intervention. An analysis of variance model was used to test for group and time effects for the WUSPI, SRQ, and satisfaction scores. RESULTS: Subjects in the intervention group showed significant improvements in all measures as a result of the intervention, whereas asymptomatic control group subjects remained stable. DISCUSSION AND CONCLUSION: A selective 8-week home exercise program is effective in reducing pain and improving function and satisfaction in this population of wheelchair users.

Adult↗
PubMed2002

A comparison of independent living outcomes following traumatic brain injury and spinal cord injury.

This study compares independent living outcomes in persons with traumatic brain injury (TBI) and spinal cord injury (SCI). Both injuries represent life-altering events that are known to have a negative impact on independent living and are predominantly experienced by members of the same demographic group. However, the types of resultant impairments and disabilities experienced by the two populations differ substantially. The TBI participants were recruited consecutively from Canada's largest tertiary care trauma centre and followed prospectively for four years. The SCI participants were recruited via a mailed survey to members of a provincial branch of the Canadian Paraplegic Association. Independent living outcomes were measured using DeJong and Hughes' (1982) classification system of productivity status, the Reintegration to Normal Living Index, and questions on assistance from environmental supports in the form of wheelchair use and paid/unpaid personal assistance. The TBI group was found to be significantly more productive, have higher levels of satisfaction with their current experience of community integration, and use fewer environmental supports than their SCI counterparts (P<or=0.0001). Methodological and demographic differences between the samples are discussed in relation to the results. The results suggest that various aspects of independent living in these two defined groups (TBI and SCI) although highly related require specific attention and that clinicians and researchers working with TBI and SCI might benefit from further collaborative efforts.

Activities of Daily Living↗