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PubMed1998

Problems, struggles and some success with spinal cord injury in Zimbabwe.

Spinal cord injury is a common occurrence in Zimbabwe and carries with it a high morbidity and mortality. In the past almost all patients discharged from hospital were dead within a year. Reasons for this high mortality are presented. The establishment of the National Rehabilitation Centre has had a profound impact on the survival of these individuals as well as on improving their quality of life. The results of a retrospective survey on the mortality and life situation of individuals with spinal cord injuries sustained through trauma are presented. However major unresolved problems are inadequate housing, lack of financial support, practically no prospect of employment and depression compounded by boredom.

Developing Countries↗
PubMed1987

[Treatment of infections of the lower urinary tract caused by multiresistant gram-negative pathogens, with ceftazidime in monotherapy of patients with spinal cord injuries].

In 53 spinal cord injury patients with neurogenic bladder suffering from severe infections caused by multiresistant gram-negative pathogens, treatment with ceftazidime at a fixed dosage schedule of 2 g i.m. for seven days, yielded an overall cure rate of 86.5%. In view of the fact that 28 episodes (52.8%) of acute infection were caused by highly resistant strains of Pseudomonas aeruginosa and considering the many aggravating factors due to the recent polytrauma and paraplegia, we consider the therapeutic results as highly satisfactory. In spinal cord injury patients in whom urinary tract infections are notoriously difficult to cure, repetitive therapy with the potentially nephrotoxic aminoglycosides should be avoided. Ceftazidime offers a valuable alternative with minimal risk of drug toxicity.

Adolescent↗
PubMed2006

Changes in cortically related intermuscular coherence accompanying improvements in locomotor skills in incomplete spinal cord injury.

In human spinal cord injury, the neuronal mechanisms mediating the improvement of locomotor function in response to intensive treadmill training are not well understood. In this study, we examined if such recovery is mediated, in part, by increases in residual corticospinal drive to muscles of the leg during walking. To do this, we measured the coherence of electromyogram (EMG) activity between two antagonist muscles (intermuscular coherence), specifically at frequencies between 24 and 40 Hz, which is thought to indicate common drive to two muscles from corticospinal inputs. In 12 subjects with incomplete spinal cord injury, intermuscular coherence was measured between hamstrings and vastus lateralis EMG that was activated during walking on a motorized treadmill. Before training, appreciable coherence in the 24-40 Hz frequency band was only present in subjects with moderate volitional motor strength in their leg muscles (n = 8 subjects) compared with subjects with little or no leg muscle strength (n = 4 subjects), reconfirming that 24-40 Hz frequency coherence is likely mediated by common supraspinal inputs. After training, increases in 24-40 Hz coherence only occurred in the eight subjects with moderate leg muscle strength who also exhibited improvements in locomotor recovery as assessed by the 21 point WISCI II scale (termed responders). In contrast, development of intermuscular coherence in the 24-40 Hz frequency band did not occur in the four subjects with absent or weak muscle strength. These subjects also did not improve in their locomotor ability as reflected in unchanging WISCI II scores (termed nonresponders). Lower-frequency coherence (5-18 Hz), which is thought to contain common drive from spinal inputs, did not change in either group. In a subset of subjects that were previously assessed with transcranial magnetic stimulation (TMS) before and after training (n = 5 responders and 3 nonresponders), there was a significant and positive relationship between increases in 24-40 Hz coherence and increases in evoked muscle responses to TMS of the primary motor cortex. Taken together, increases in higher-frequency EMG coherence in subjects with residual voluntary muscle strength and its parallel relation to changes in TMS-evoked responses provides further evidence that improvements in locomotor function from treadmill training are mediated, in part, by increases in corticospinal drive to muscles of the leg during walking.

Adult↗
PubMed1993

Atypical syndromes caudal to the injury site in patients following spinal cord injury. A clinical, neurophysiological and MRI study.

Some patients with a cervical or a high thoracic spinal cord injury show atypical signs and symptoms such as atrophy of lower leg muscles, reduced tendon jerks or urinary retention, either persisting from the acute phase or developing in the course of time. A series of 35 patients was prospectively examined from this point of view with neurophysiological, urodynamic and MRI studies. Seven patients (20%) presented atypical findings; in two there was an isolated areflexic bladder, but no signs of functional or structural sacral damage were found. In five patients (14.2%) a definite cause for the sacral lesion could be detected. The syndrome caudal to the level of the lesion is neither obvious at the beginning nor immutable in time. Treatment requires to be adapted to the changing patterns of somatic and visceral activity.

Adolescent↗
PubMed1993

Sexual activities, response and satisfaction in women pre- and post-spinal cord injury.

Twenty-five spinal cord injured (SCI) women (median age = 34) completed an 80-item multiple choice questionnaire (median 50 months postinjury) that assessed sexual functioning pre-spinal cord injury and post-spinal cord injury in four areas: (1) sexual adjustment; (2) sexual activities and preferences; (3) sexual desire, arousal and satisfaction; and (4) sexual abilities. Frequency of sexual activity decreased following SCI. Intercourse was the favorite activity preinjury; whereas, kissing, hugging and touching were favored postinjury. Sexual desire and satisfaction decreased postinjury. Ability to achieve lubrication and orgasm with various types of spinal injuries is reported. Although most women did not receive sexual information or counseling, 76% of the sample believed they had been adjusting well sexually. Results are discussed accounting for the limitations of self-report methodology in sexuality research. The need for laboratory based, physiologic studies is underscored.

Adolescent↗
PubMed1995

Injury pattern effect on motor recovery after traumatic spinal cord injury.

OBJECTIVE: To determine whether type of fracture or gunshot injury correlated with extent of motor impairment at 1 month and/or with the amount of motor recovery between 1 month and 1 year. DESIGN: Prospective neurological examinations were performed longitudinally after the recommendations of the American Spinal Injury Association (ASIA). Fractures were classified by the Allen system (cervical spine) or the Denis system (thoracic and lumbar spine). Gunshot injuries were classified based on trajectory and bullet location. SETTING: Subjects were examined at a community medical center. PATIENTS: There were 278 patients with traumatic spinal cord injury who were admitted between 1985 and 1990. MAIN OUTCOME MEASURES: The ASIA motor score was the primary outcome measure. RESULTS: There were no significant differences in motor recovery based on type of injury (penetrating vs nonpenetrating), type of fracture, or bullet location. CONCLUSIONS: Injuries severely disruptive of the spinal canal were more likely to result in complete SCI. Flexion-rotation injuries in the thoracic and lumbar spine, bilateral facet dislocations in the cervical spine, and gunshot wounds in which the bullet passed through the canal were more likely to be complete. Incomplete injuries were more common among patients with preexisting cervical spondylosis who had fallen and patients with gunshot wounds in which the bullet did not penetrate the spinal canal. The primary determinant of motor recovery was completeness of injury at 1 month.

Adult↗
PubMed1994

Rapid eye movement sleep periodic leg movements in patients with spinal cord injury.

We describe three spinal cord injury cases exhibiting periodic leg movements (PLMs) in both rapid eye movement (REM) and nonrapid eye movement (NREM) sleep. The difference in the average periodicity in REM and NREM sleep was modest, but was generally shorter in REM than in NREM sleep. However, the variability associated with the PLMs was nearly three to six times smaller in REM than in NREM sleep, suggesting that the periodicity of the PLMs in REM sleep was more precise than in NREM sleep. The finding of PLMs in these patients suggests that a spinal cord injury may permit the expression of a spinal PLM generator, which may be an unusual presentation of a spinal locomotor generator. The PLM generator would be displayed when the descending inhibitory spinal pathways are interrupted by a spinal injury. The rapid periodicity of the PLM generator in REM sleep, compared with NREM sleep, may result from an increase in sympathetic activity normally accompanying this sleep state. Alternative explanations for the occurrence of PLMs in spinal injury are the influence of adverse sleeping position, age, an increase in circulating catecholamines and peripheral perfusion. We conclude that the presence of PLMs may be an important, but neglected, sleep disorder in spinal cord patients. Therefore, health care professionals should be aware of the possibility of sleep-related PLMs when these patients have sleep and/or waking complaints.

Adult↗
PubMed2000

Riluzole improves measures of oxidative stress following traumatic spinal cord injury.

Rats received a contusion injury to the spinal cord followed by treatment with riluzole (a glutamate release inhibitor, 8 mg/kg), methylprednisolone (MP 30 mg/kg) or both. At 4 h following injury, spinal cords were removed and synaptosomes prepared and examined using five measures of oxidative stress. Riluzole treatment was found to improve mitochondrial function, and enhance glutamate and glucose uptake. As expected, MP treatment was found to reduce lipid peroxidation, but also improved glutamate and glucose uptake. Interestingly, the combination treatment was found to be effective in improving all five measures of oxidative stress. The results of this study clearly demonstrate the potential beneficial effects of a combination approach in the treatment of oxidative stress events in traumatic spinal cord injury.

Animals↗
PubMed2002

Spinal cord injury and male infertility.

Spinal cord injury (SCI) commonly affects males in their reproductive years. After spinal cord injury, most men experience fertility related problems including erectile and ejaculatory dysfunction, impaired spermatogenesis, abnormal sperm viability, motility, and morphology, genitourinary infection and endocrine abnormalities. In this article we will review the pathophysiology, evaluation and management of infertility in spinal cord injury. The impact of spinal cord injury on seminal plasma and the contribution of seminal oxidative stress to the poor sperm quality of men with spinal cord injury will be presented. Success with sperm retrieval techniques and assisted reproductive technology in SCI men with spinal cord injury will be discussed.

Ejaculation↗
PubMedDate not supplied

Regional and temporal changes in prostaglandin E2 and thromboxane B2 concentrations after spinal cord injury.

BACKGROUND CONTEXT: Inflammatory metabolites of arachidonic acid likely play a significant role in secondary injury after spinal cord trauma. PURPOSE: We sought to characterize the regional and temporal alterations in prostaglandin concentrations after injury in a rat model. STUDY DESIGN/SETTING: Prostaglandin E2 (PGE2) and thromboxane B2 (TxB2) concentrations were measured in cerebrospinal fluid (CSF) and in different parts of the injured spinal cord at various time points after spinal cord injury. OUTCOME MEASURES: PGE2 and TxB2 levels were measured by means of an enzyme immune assay. METHODS: Forty-six adult Long Evans rats were subject to spinal cord injury using the NYU impactor. Animals were divided into three groups. Fourteen animals were used in a pilot study to determine the timing and location of PGE2 production after spinal cord injury. These animals were sacrificed, and samples of injured cord, rostral cord and CSF were assayed for PGE2 concentration. The remaining 32 animals were used to establish the time course of prostaglandin production. Twenty-eight animals were subjected to a spinal cord injury, and four animals served as sham-operated controls. These animals were sacrificed at predetermined time points 2 to 72 hours after injury, and the injured segments of spinal cord were harvested. RESULTS: Both PGE2 and TxB2 concentrations increased immediately after injury in the injured segment. PGE2 concentrations increased faster and more dramatically in the injured segment of spinal cord than in CSF or noninjured segments. Elevations in PGE2 and TxB2 concentrations were persistent for 72 hours after injury. CONCLUSION: Elevated concentrations of arachidonic acid metabolites can be detected in the injured segment of the spinal cord for at least 72 hours after injury. Concentration changes are detected earlier and are more dramatic in the injured cord segment than in rostral segments or the CSF.

Animals↗
PubMed1993

Recovery of function after spinal cord injury: mechanisms underlying transplant-mediated recovery of function differ after spinal cord injury in newborn and adult rats.

Fetal spinal cord transplants placed into the site of spinal cord injury support axonal growth of host systems in both newborn and adult animals. The amount of axonal growth, however, is much more robust in the newborn animals. The current studies were designed to determine if the differences in the magnitude of the anatomical plasticity of host pathways in the presence of transplants is reflected in differences in recovery of function between the neonatal and adult operates. Newborn and adult rats received a midthoracic "overhemisection." Immediately following the hemisection embryonic (E14) spinal cord transplants were placed into the lesion site. All animals were trained and tested as adults, on a battery of qualitative and quantitative tests of motor function. Immunocytochemical methods were used to compare the extent of growth of descending (serotonergic and noradrenergic) and segmental (calcitonin gene-related peptide containing dorsal root axons) pathways in both groups. The growth of descending pathways into the transplants was substantially greater in density and spatial extent after lesions at birth than at maturity. The distribution of segmental dorsal root axons, in contrast, was similar in both groups. Fetal spinal cord transplants promoted recovery of motor function in both newborn and adult operates. The particular aspects of locomotor function which recover differ between the neonatal and adult operates, suggesting that the mechanisms underlying recovery of function must differ between the two groups.

Aging↗
PubMed2000

The early assessment and intensive care unit management of patients with severe traumatic brain and spinal cord injuries.

The assessment and management of neurotrauma have progressed significantly over the past several years. Improved understanding of the physiology of injured neural tissue and advances in technology have refined the approach to the care of patients suffering neurologic injury. Evidence-based clinical management guidelines, such as those developed by the Brain Trauma Foundation and the American Association of Neurological Surgeons, for the management of traumatic brain injury have been introduced to standardize certain aspects of care. The ongoing evolution of critical care also has had a significant impact on the care of patients suffering from neurotrauma. This article reviews some current issues related to the diagnosis and management of traumatic brain injury and spinal cord injury as we head into the next millennium.

Brain Injuries↗
PubMed2004

Concentrations of glutamate released following spinal cord injury kill oligodendrocytes in the spinal cord.

We investigated in vivo in rats whether sufficient glutamate is released following spinal cord injury (SCI) to kill oligodendrocytes. Microdialysis sampling was used to establish the level of glutamate released (550 +/- 80 microM) in the white matter during SCI. This glutamate concentration was administered into the spinal cords of other rats and the densities of oligodendrocytes remaining 24 and 72 h later determined by counting cells immunostained with the oligodendrocyte marker CC-1. Administration of ACSF, 4.0 mM glutamate (estimated resulting tissue exposure 500 microM) and 10.0 mM glutamate by microdialysis reduced oligodendrocyte density 22%, 57%, and 74%, respectively, relative to normal at 24 h post-exposure. Therefore, sufficient glutamate is released following SCI to damage white matter. Oligodendrocyte densities near the fiber track were not significantly different at 72 h from 24 h post-exposure, so most glutamate-induced oligodendrocyte death occurs within 24 h after exposure. Injecting the AMPA/kainate receptor blocker NBQX into the spinal cord during glutamate administration reduced the glutamate-induced decrease in oligodendrocyte density, evidence for AMPA/kainate receptor involvement in glutamate-induced oligodendrocyte death. This work directly demonstrates in vivo that following SCI glutamate reaches concentrations toxic to white matter and that AMPA/kainate receptors mediate this glutamate toxicity to oligodendrocytes.

Animals↗
PubMed1985

Contractures complicating spinal cord injury: incidence and comparison between spinal cord centre and general hospital acute care.

One hundred and eighty-one spinal cord injured patients admitted to the Rehabilitation Institute of Chicago after acute care following a spinal cord injury were studied. The presence or absence of contractures as well as significant abnormalities with loss of range of motion greater than 15% was recorded. Patients were either admitted from general hospitals or the acute care unit of our spinal centre, Northwestern Memorial Hospital. Patients treated in the general hospitals had a statistically significant increased incidence of contractures compared to spinal centre patients. Patients treated in the spinal centre were transferred to the rehabilitation hospital sooner post injury. An increased time from onset to rehabilitation admission correlated with a statistically significant increased incidence of contractures. Tetraplegic patients had a statistically significant increase over paraplegic patients and were more likely to have contractures of several upper extremity joints. Contracture development was not related to fractures of the extremities. This evidence further supports the need for spinal cord centres and provides data on the incidence of contractures in spinal cord injured patients which has not been reported previously.

Adult↗
PubMed1995

Failure of methylprednisolone to improve the outcome of spinal cord injuries.

The infusion of methylprednisolone (MP) within 8 hours of injury for spinal cord injuries (SCI) has been advocated to improve the motor function of patients after this catastrophic injury. However, clinical improvement in the outcome of SCI has not been consistently identified, despite the use of MP. We reviewed the outcome of SCI patients with MP to those without MP (No-MP) at two Level I Trauma Centers from 1989-1992. Acute SCI patients were identified from the trauma registries with trauma demographics and hospital data obtained from registry and medical records. Rehabilitation data for Functional Independence Measure (FIM) was obtained from the rehabilitation institute database. Primary outcome parameters were mortality, and for survivors, patient mobility (6 point scale) and FIM scores. There were 145 acute SCI patients: 80 treated with MP and 65 with No-MP. FIM data was available on 45 MP and 25 No-MP patients. There was no difference in the admission trauma score, ICU length of stay (LOS), or hospital LOS between the two groups. The MP patients were significantly younger (30 years vs 38 years, P = < 0.05) and had lower ISS scores (24 vs 31, P = < 0.05). There was no statistically significant difference in mortality (MP, 3.8% vs No-MP, 10.7%) between the two groups. Although admission mobility was not statistically different (MP, 5.99 vs No-MP, 5.90), there was a significantly poorer discharge mobility in the MP group when compared to the No-MP group (MP, 5.16 vs No-MP, 4.67, P = < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗