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PubMed2006

Chondroitinase ABC promotes axonal re-growth and behavior recovery in spinal cord injury.

In spinal cord injury, the injury could trigger some inhibitory signal cascades to promote chondroitin sulfate proteoglycans (CSPGs), the structures of scar tissues, formation. CSPGs could limit axonal regeneration mainly through the glycosaminoglycan (GAG) chain in the lesion site were suggested. We hypothesized that the digestion of CSPGs by chondroitinase ABC (ChABC) might decrease the inhibitory effects of limiting axonal re-growth after spinal cord injury. We compared the digesting products of CSPGs such as 2B6 by ChABC with the untreated control group and found no immunostaining of 2B6 in control group. The smaller size scars of ChABC-treatment were observed via CS-56, a type of CSPGs, 8 weeks after transection by immunohistochemistry. The inhibitory effects of CSPGs withdraw GAGs following ChABC-treatment would reduce, and immunopositive GAP-43 newly outgrown fibers were identified. In the animal trials, ChABC-treatment could improve motor function through BBB locomotor's test and reduce limiting ability of scar tissues to promote axonal regeneration via changing the structure of CSPGs by immunohistochemistry with GAP-43.

Animals↗
PubMed2002

Post-injury substance abuse among persons with brain injury and persons with spinal cord injury.

PRIMARY OBJECTIVE: To identify the patient population at greatest risk for post-injury adjustment problems, the present study independently examines and compares alcohol and drug use rates in patients with traumatic brain injury (TBI) and patients with spinal cord injury. RESEARCH DESIGN: The two samples were matched with regard to age, gender and mechanism of injury. The study provides a description of post-injury use rates for each population, and describes similarities and differences between the two groups. METHODS AND PROCEDURES: Participants included 30 consecutive Model Systems spinal cord injury (SCI) patients seen for follow-up neuropsychological testing between October 1996-June 1999. An equivalent number of Model Systems TBI patients were matched from a larger sample comprised of 440 consecutive hospital admissions, that returned for a 1-year follow-up neuropsychological evaluation between February 1989-December 1998. All participants were treated in an urban Level I trauma centre and associated inpatient rehabilitation programmes. Information regarding patient demographics, as well as pre- and post-injury psychiatric, employment, academic, criminal, and medical history was obtained via the General Health and History Questionnaire. MAIN OUTCOMES AND RESULTS: With regard to post-injury alcohol use rates, persons with spinal cord injury were more likely to drink on a daily basis. Although not statistically significant, pre-injury drinking rates differed from post-injury rates for both groups. With regard to illicit drug use, persons with TBI differed significantly from persons with SCI. A significant difference was also noted between pre-injury drug use and post-injury drug use for both groups. CONCLUSIONS: Persons who drink post-injury are unlikely to be 'light' or social drinkers. Either people choose to abstain completely or appear to use alcohol frequently.

Adjustment Disorders↗
PubMed2006

Upregulation of persistent and ramp sodium current in dorsal horn neurons after spinal cord injury.

Traumatic spinal cord injury (SCI) results not only in motor impairment, but also in chronic central neuropathic pain, which often is refractory to conventional treatment approaches. Upregulated expression of sodium channel Nav1.3 has been observed within the spinal dorsal horn neurons after SCI, and appears to contribute to neuronal hyperresponsiveness and pain-related behaviors. In this study we characterized the changes in sodium current properties within dorsal horn neurons after contusive SCI. Four weeks after adult male Sprague-Dawley rats underwent T9 spinal cord contusion injury, when behavioral nociceptive thresholds were decreased to both mechanical and thermal stimuli, whole-cell patch-clamp recordings were performed on acutely dissociated lumbar dorsal horn neurons. The cells demonstrated characteristic fast-activating and fast-inactivating sodium currents. SCI led to a shift of the steady-state activation and inactivation of the sodium current towards more depolarized potentials. The shifted steady-state inactivation shows similarities to that obtained from axotomized dorsal root ganglions, which were shown to upregulate Nav1.3. Small slow depolarizations below action potential threshold produced ramp currents, which were markedly enhanced by SCI (from 182 +/- 41 to 338 +/- 55 pA). The density of the noninactivating persistent sodium current was also significantly enhanced in neurons from SCI animals (from 17.4 +/- 3.2 to 27.7 +/- 4.4 pA/pF at 50-70 ms of depolarization). The increased persistent sodium current and ramp current, which are consistent with upregulation of Nav1.3 within dorsal horn neurons, suggest a basis for the hyperresponsiveness of these neurons following SCI.

Animals↗
PubMed1989

[Spinal cord evoked potential in experimental spinal cord injury: the changes of spinal cord evoked potential following impact injury, and the correlation between the change in amplitude of the spinal cord evoked potential after injury and the prognosis for motor recovery of legs].

The authors reported the changes of spinal-cord-evoked potential following impact injury by the weight dropping technique (Allen's method). The correlation between the change in amplitude of the spinal-cord-evoked potential after injury, and the prognosis for motor recovery of the legs was discussed. The spinal cord of adult dogs was traumatized by the weight dropping technique (Allen's method) at the level of Th10. The trauma consisted of a 300 gm-cm impact injury, a 400 gm-cm impact injury, and a 500 gm-cm impact injury. The spinal-cord-evoked potential following direct stimulation of the spinal cord was recorded from the epidural space for 5 hours. The recording electrode was located cephalad to the site of the impact injury. The stimulating electrode was located at the caudal site of the injured area. The motor function of the dogs was observed by clinical scale for rating hind limb motor function (modified Tarlov score) for one month after the trauma. The recovery of the spinal cord evoked potential following impact injury by the weight dropping technique could be estimated one hour after trauma in the 300 gm-cm injury, 30 minutes after trauma in the 400 gm-cm injury and immediately only after trauma in the 500 gm-cm injury. A greater reduction of amplitude of I potential was noted with the higher energy injury (p less than 0.05). There was no parallel correlation between the change in amplitude of the spinal cord evoked potential after injury and the prognosis for motor recovery of legs. However, the changes in amplitude corresponded moderately well to the prognosis of motor function.

Animals↗
PubMed2005

Current status of clinical trials for acute spinal cord injury.

Acute spinal cord injury (ASCI) occurs as a result of physical disruption of spinal cord axons through the epicenter of injury leading to deficits in motor, sensory, and autonomic function. This is a debilitating neurological disorder common in young adults that often requires life-long therapy and rehabilitative care, placing a significant burden on our healthcare system. While no cure exists, research has identified various pharmacological compounds that specifically antagonize primary and secondary mechanisms contributing to the etiology of ASCI. Several compounds including methylprednisolone (MPSS), GM-1 ganglio-side, thyrotropin releasing hormone (TRH), nimodipine, and gacyclidine have been tested in prospective randomized clinical trials of ASCI. MPSS and GM-1 ganglioside have shown evidence of modest benefits. Clearly trials of improved neuroprotective agents are required. Promising potential therapies for ASCI include riluzole, minocycline, erythropoietin, and the fusogen polyethylene glycol, as well as mild hypothermia.

Clinical Trials as Topic↗
PubMed1995

Motorcycle trauma in the state of Illinois: analysis of the Illinois Department of Public Health Trauma Registry.

STUDY OBJECTIVE: To assess the current morbidity and mortality of motorcycle trauma in the state of Illinois and, specifically, to assess the incidence and cost of head injury to motorcycle crash patients according to their helmet use. DESIGN: Retrospective, cross-sectional examination of the Illinois Department of Public Health Trauma Registry, for which data are available from July 1, 1991, through December 31, 1992. Data are collected from all hospitals designated as Level I or Level II trauma centers in Illinois. PARTICIPANTS: All patients involved in motorcycle crashes and subsequently taken to a Level I or Level II trauma center in Illinois and entered into the trauma registry during the period studied. RESULTS: Head injury, spinal injury, helmet use, demographic data, hospital charges, days in ICU, and source of payment were selected as outcome measures. During the 18-month study period, 1,231 motorcycle trauma patients were entered into the trauma registry. Eighteen percent were helmeted and 56.0% were nonhelmeted. In 26.0% the helmet status at the time of the crash was unknown. Thirty percent of the helmeted patients sustained head injury and 4% sustained spinal or vertebral injury, compared with 51% and 8%, respectively, for nonhelmeted patients. Nonhelmeted patients were significantly more likely to sustain severe (Abbreviated Injury Score [AIS], 3 or more) or critical (AIS, 5 or more) head injury. Patients with these serious head injuries incurred almost three times the hospital charges and used a disproportionately larger share of ICU days than those with mild or no head injuries. There was a trend toward greater use of public funds or self-pay status (no insurance) for payment of hospital charges in nonhelmeted patients. CONCLUSION: Motorcycle helmet nonuse was associated with an increased incidence of serious head injury. Motorcycle trauma patients with severe or critical head injuries used a significantly greater proportion of ICU days and hospital charges than those with mild or no head injuries.

Accidents, Traffic↗
PubMed2004

Head injury and pulmonary embolism: a retrospective report based on the Pennsylvania Trauma Outcomes study.

OBJECTIVE: We retrospectively examined the database of the Pennsylvania Trauma Systems Foundation to determine the risk of pulmonary embolism in adult patients sustaining isolated head trauma or multiple injuries, including head trauma, to answer two questions: What is the incidence of symptomatic pulmonary embolism during hospitalization in a trauma center in patients who have sustained a head injury? Are patients with head injuries more at risk for pulmonary embolism than trauma patients without head injuries? METHODS: We determined the total number of adult submissions per year to the Pennsylvania Trauma Outcomes Study from 1992 to 1996. Age, sex, Glasgow Coma Scale score, Abbreviated Injury Score for head injury, Injury Severity Score, intensive care unit days, hospital days, and the presence or absence of head injury, spinal injury, pelvic fractures, and/or femur fractures were recorded. Statistical techniques to evaluate their correlation with the incidence of pulmonary embolism included chi(2) testing, linear regression analysis, Kendall analysis, and logistic regression analysis. RESULTS: The average incidence of symptomatic pulmonary embolism in head-injured patients occurring during their acute hospital stay was 0.38%. This rate was not significantly greater than the 0.27% incidence of pulmonary embolism in patients without head injury. Factors that significantly increased this incidence were age greater than 45 years, Injury Severity Score greater than 15, male sex, and the presence of pelvic or femur fractures or of spinal cord injury. CONCLUSION: We found no evidence that head injury is a significant independent risk factor for development of symptomatic pulmonary embolism during the acute hospitalization of the trauma patient.

Abbreviated Injury Scale↗
PubMed2001

Spinal and supraspinal changes in opioid mRNA expression are related to the onset of pain behaviors following excitotoxic spinal cord injury.

Excitotoxic spinal cord injury (SCI) causes anatomic, physiologic and molecular changes within the spinal cord and brain. Intraspinal injection of quisqualic acid (QUIS) produces an excitotoxic injury that leads to the onset of behavioral syndromes, believed to be related to the clinical condition of chronic pain. The opioid system, classically involved in the suppression of pain transmission, has been associated with the onset of pain-related behaviors and changes in spinal opioid peptide expression have been demonstrated in various models of SCI and chronic pain. Recently, changes in opioid peptide expression have been demonstrated in both spinal and supraspinal areas following excitotoxic SCI. Therefore, the purpose of this study was to examine changes in opioid peptide gene expression as they relate to the onset of pain behaviors following excitotoxic SCI. Male, Long-Evans rats were given an intraspinal injection of 1.2 microl of 125 mM QUIS and allowed to survive for 10 days, a duration sufficient for the development of pain-related behaviors. Animals were assessed daily for the presence of excessive grooming behavior, i.e. self-directed biting and scratching resulting in damage to superficial and deeper layers of the skin. Animals were also tested for thermal hypersensitivity using a cold plate apparatus on days 5, 7, and 10 following QUIS injection. After sacrifice, quantitative in situ hybridization was performed on regions of the spinal cord surrounding the lesion site as well as whole brain sections through various levels of the thalamus and cortex. Spinal preproenkephalin (PPE) and preprodynorphin (PPD) expression was significantly increased in animals that developed excessive grooming behaviors vs. those that did not. For PPE, this difference was seen bilaterally, in areas of cord caudal to the site of injury. For PPD, this difference was seen only ipsilateral to the site of injection, rostral to the site of injury. In addition, PPE expression in the anterior cingulate cortex and PPD expression in the contralateral parietal cortex were significantly higher in grooming vs. non-grooming animals. These results support previous conclusions that both spinal and supraspinal regulation of endogenous opioid peptide expression plays a role in the response to or onset of post-SCI pain. These results also suggest that the opioid peptides are regulated independently and serve different functions in response to SCI.

Animals↗
PubMed1977

'Burning hands' in football spinal cord injuries.

Central spinal cord injury in two high school football players caused only complaints of burning paresthesias and dysesthesias in the hands at the time of injury. Strength was affected only in the upper extremities where it was slightly reduced. Failure to recognize the relationship of "burning hands" as a symptom of cord injury can result in injudicious management of unstable cervical fracture dislocations with disastrous consequences.

Acute Disease↗
PubMed2002

Injury patterns associated with mortality following motorcycle crashes.

All patients involved in motorcycle crashes admitted to various hospitals in the Yorkshire region of UK between January 1993 and December 1999 were retrospectively reviewed to identify the factors that are likely to predict a reduced survival. Of the 1239 patients requiring hospital admission, 74 died. The probability of reduced survival was estimated by a logistic regression model using independent variables such as head injury, thoracic trauma, abdominal injury, spinal injury and pelvic fracture and a compound variable of pelvic fracture combined with a long bone fracture. The odds ratio for head injury was 0.349, chest injury 0.39, abdominal injury 0.42, and the compound variable (pelvis plus a long bone fracture) 0.576. The mean injury severity score (ISS) in the fatal group was 35.96 compared to 12.2 in the group that survived (P<0.01). There was a significant difference in the Glasgow coma scale (GCS) between patients wearing a helmet and those that did not wear any protective headgear (P=0.0007). Head injury followed by chest and abdominal trauma were found to predict a reduced survival rate. Use of helmets should continue to be compulsory. Chest and abdominal injuries should be diagnosed and treated early to reduce mortality.

Abdominal Injuries↗
PubMed1989

Humanistic aspects of sexuality as related to spinal cord injury.

As spinal cord injury results in loss of motor, sensory and autonomic function, spinal cord-injured individuals sense a loss of their sexuality. Therefore, it is important that patients receive sexual counseling. With encouragement and education, they have the potential to learn new ways of achieving sexual gratification. Through the acquisition of knowledge about sexuality and adaptive techniques, nurses have the power to teach factual information and provide resources as necessary, resulting in healthful transition post-injury.

Attitude of Health Personnel↗
PubMed2005

The effect of different physiological stimuli on skin vasomotor reflexes above and below the lesion in human chronic spinal cord injury.

OBJECTIVE: Spinal cord injury (SCI) results in disruption of descending tonic activation of sympathetic circuits in the spinal cord. The authors determined whether different stimuli that increase sympathetic activity induced cutaneous vasoconstriction (skin vasomotor reflex, SkVR) above and below the level of lesion in subjects with clinically complete SCI. METHODS: Baseline skin blood flow (SkBF) and SkVR reduction rate in the pulp of the finger and great toe was measured by laser Doppler probes in chronic complete SCI and in controls. RESULTS: In the finger, baseline SkBF was similar in SCI and controls. The SkVR was elicited by all stimuli in controls but was significantly diminished to gasp, mental arithmetic, tactile stimulation, cutaneous cold, and deep breathing in high SCI compared to controls. In the toe, baseline SkBF was less stable in both controls and SCI. SkVR trends were identified in controls, and responses were not present or greatly reduced in high and low SCI. CONCLUSIONS: Measurements of skin vasomotor reflexes to physiological stimuli may be a noninvasive method to evaluate the extent of sympathetic adrenergic pathways in chronic SCI. This is of clinical relevance in monitoring recovery of sympathetic adrenergic function either spontaneously or following repair interventions.

Adult↗
PubMed1999

Magnetic resonance imaging and neurological recovery in acute spinal cord injury: observations from the National Acute Spinal Cord Injury Study 3.

STUDY DESIGN: Data are from a multicenter, randomized, double blind clinical trial of acute spinal cord injury. OBJECTIVES: To evaluate the prognostic value of magnetic resonance imaging (MRI) for randomized patients in the National Acute Spinal Cord Injury Study 3 (NASCIS). SETTING: Sixteen spinal cord injury centers throughout the United States and Canada. METHODS: Of 499 patients randomized in NASCIS 3 between December 1991 and September 1995, MRI was electively done on 191 patients within 72 h of injury. Indications of hemorrhage, edema, and contusion were recorded by standard protocol. Neurological impairment as determined by motor function, response to pin prick and light touch was assessed at admission to the participating center and 6 weeks after injury. Change in neurological function was obtained by subtracting the score of each neurological parameter at admission from that measured at 6 weeks. Spinal cord surgery performed within the 3 days after injury was noted. Data were analyzed by: chi square, analysis of variance, multiple logistic regression and linear regression models. RESULTS: Patients with hemorrhage were much more likely to have a complete injury (OR=2.88, 95 Cl 1.32, 6.23); however this association was much reduced when the initial neurological examination was taken into account (AOR=1.43, 95% Cl 0.55, 3.73) and was no longer a significant predictor of injury. MRI evidence of cord edema was the strongest predictor of reduced improvement in motor function (-3.34 points, P=0.06) and light touch sensation (-3.41 points, P=0.05) at 6 weeks. CONCLUSIONS: Cord hemorrhage, contusion, and edema on MRI were not associated with diagnosis of a complete cord injury after neurological assessment from the initial clinical examination was taken into account. Prediction of a worse 6 week neurological status was weakly associated with the presence of edema diagnosed by MRI. As MRI technology improves, these diagnostic and predictive capabilities need to be re-assessed. SPONSORSHIP: NASCIS 3 was funded by the National Institute of Neurological Disorders and Stroke at the National Institutes of Health, Washington, DC, USA. Pharmacia and Upjohn provided study drugs and placebos; they also monitored data quality, and funded additional tests, in accordance with Food and Drug Administration regulatory requirements. Dr Bracken has served as an occasional paid consultant to Pharmacia and Upjohn.

Adolescent↗
PubMedDate not supplied

Delayed spinal cord injury after high-voltage electrical injury.

Delayed spinal cord injury is a rare complication of high-voltage injury. The diagnosis of this scenario is difficult because radiologic imaging techniques lack sensitivity. Frequent neurologic assessments, although difficult to perform in the early stages of such multisystem traumas, are required for accurate diagnosis.

Adult↗
PubMed2000

Neurologic injuries in skiers and snowboarders.

Neurologic injures are the leading cause of death and disability in skiing and snowboarding accidents, despite accounting for only a small fraction of injuries overall. Head injuries make up 3 to 15% of all skiing and snowboarding related injuries, spinal injuries account for 1 to 13%, and peripheral nerve injuries constitute less than 1% of reported injuries. Improvements in equipment and technology, especially advances in binding technology, have resulted in decreased injury rates on the slopes overall, but neurologic injury rates have not decreased, and in fact appear to be increasing as a percentage of overall injuries and in absolute numbers. With advances in technology and slope maintenance, skiers and boarders progress to higher skill levels and faster speeds more rapidly than ever before. Great efforts have been focused on reducing extremity injuries in skiers and snowboarders, but until recently very little attention has been given to neurologic injury prevention on the slopes. Hopefully with increased awareness and the growing popularity of ski/snowboard helmets, we will begin to see head injury rates (and maybe even spine injury rates) decrease among skiers and snowboarders.

Accident Prevention↗